Preparation of youth in congregate care for independent living

This paper reports on findings from a qualitative study that focused on the quality and adequacy of preparation of youth in congregate care for independent living. This study, conducted in New York, NY, USA, explored the extent to which youth feel prepared to leave care and the opportunities they are given to participate in planning and decision‐making regarding issues that personally affect their future. Interviews were conducted with professionals and young adults who had exited foster care after placements in congregate care settings. Both professionals and young adults stated concerns about the quality of independent living preparation. Many young adults stated that they were not ready to live independently and expressed concerns about failure of staff to begin preparing youth sufficiently in advance of their discharge dates. Young adults also reported limited opportunities to participate in the planning and decision‐making processes affecting them. Recommendations for improvement of independent living preparation are proposed.     

Advocacy for disabled children and young people: benefits and dilemmas

Recent policy has emphasized the need for advocacy services for children and young people, developments that have gone hand‐in‐hand with greater levels of participation of young people in decision‐making. Advocacy for disabled young people is especially important, as they are a particular vulnerable group and have, traditionally, been even more excluded from decisions about matters affecting their lives. This paper reports the findings, as they relate to disabled young people, from a study that investigated the role of advocacy for looked‐after children and children in need. The paper highlights some of the benefits of advocacy for disabled children, the dilemmas facing advocates between advocating and acting in someone's ‘best interests’, identifying the client and the boundaries between advocacy and social work. It argues that time given to establish a close relationship with a disabled child or young person is crucial if advocacy is to be effective and participation in decisions affecting their lives a reality.     

Participation of youth in decision‐making procedures during residential care: A narrative review

Participation in decision‐making procedures of young people in care is considered a key element that affects their current or future living circumstances and might improve the quality of decision‐making on and delivery of provided services. This narrative literature review, covering the period 2000–2016, focuses on the opportunities of young people to participate, the challenges and facilitators to participation, and the outcomes of care related to participation. Sixteen studies met our search criteria. Several studies show that young people seem to have limited possibilities to “meaningful” participation in decision‐making. Various challenges and facilitators in the participation process emerge with regard to the level of the young person, the professional, and the (sociocultural) context. None of the studies provides evidence for a connection between the “amount” of youth participation in decision‐making and/or treatment during the care process and the outcomes of residential care. Implications for research and practice are reflected upon.     

Admission to Nursing Homes in Taiwan

The population of Taiwan is facing a radical ageing process. A proportion of the growing number of people aged 65 and over is expected to need nursing home care. This research concerns the family context of decision‐making in the process of admission to a nursing home in Taiwan. Employing survey data from interviews with elderly people in nursing homes (235 interviews) and their carers/key families (265 interviews), the factors affecting their views about admission were explored. Bivariate analysis and a logistic regression model were also used to examine perceptions of alternatives to nursing home care among family members with elderly relatives in nursing homes. Most elderly people in Taiwan are cared for in their own homes by their families but, in some circumstances, entry to a nursing home seemed inevitable. This research found that the decisions were taken mainly within a family context. The adult children of the elderly people, carers/key families’ preferences and the availability of carers influenced the decision. Apart from the important need factors of elders, families’ views about alternatives to nursing homes were significantly influenced by their preferences. This study has important implications for long‐term care in Taiwan. It is hoped that this will be needs‐led, both by elderly people and their families.     

The school to work transition for young people in state care: perspectives from young people,carers and professionals

Workforce participation has many positive effects on quality of life. However, as young people in care have generally below‐average levels of educational participation and attainment, they may be ill‐equipped for the transition to further education and work. A mixed‐method study conducted in Australia about career development for young people in care investigated how this population develops ideas about future work: the social and cognitive variables that influence career decision‐making; practices for preparing young people in care for the transition to work or further education; and factors that support or impede the transition. Findings from the qualitative study are reported in this paper. Interview data were obtained from the multiple perspectives of young people in care, foster carers, caseworkers and school personnel. The overall picture was one of young people in care lacking the encouragement, resources and capacity to realistically plan for the job they want. Specific interventions are required to enhance career development and employment outcomes for this population.     

Family contact in foster care in Portugal. The views of children in foster care and other key actors

This is a pilot study on the sensitive issue of how children and young people experience family contact in foster care, and the views of key adults in their lives on the same issue. There is a special focus on the children's experiences, opinions, and feelings. The study is a response to the relative scarcity of literature on family contact based on the experiences of children and adults in caring roles. This is a qualitative and exploratory study, with a sample of 10 children and young people in care in the district of Porto, aiming to identify key issues and areas for further examination. The results allow us to conclude that the possibility of maintaining contact is positively evaluated. However, perspectives on the relationships involved, and on the reactions to and difficulties associated with visits, revealed considerable disagreement among the actors. A possible set of implications drawn from the findings pointed out to the importance of developing a monitored cooperation that improves communication processes in order to take into account the children's and young people's views in the decision‐making process; and to develop more attentive and open working relationships with parents throughout the foster care placement.     

Navigations between regulations and gut instinct: the unveiling of collective memory in decision‐making processes where teenagers are placed in residential care

The decision to take a young person away from his or her family into out‐of‐home care and treatment is the most drastic intervention within the statutory powers bestowed upon social services. The results of reports on the quality of residential treatment reveal that state supervision has not proven to be a good substitute for parental care. In this paper we analyse the decision‐making process when young persons are placed in residential care. Focus groups and individual interviews with different stakeholders were conducted. The results show that the placements are a collective process involving negotiations between the different parties with a coordinating social worker in the middle, with the aim to bring something to build hope on in often desperate situations, regardless of the specific treatment method used. To inform the process, the social workers draw on a ‘collective memory’ shared among colleagues in the department. Important signs of quality of a residential unit were the relational and collaborative competence from the staff. The inclination to use soft, diffuse information in decision‐making shows a striking lack of evidence upon which social workers can build well‐informed and knowledge‐based decisions.     

Health Care Fraud and Industry Structure in the United States

The cost of health care fraud and abuse is enormous. Not only is it costing us a lot of money but one wonders how many more people could afford and receive medical insurance if fraud and abuse were significantly lower. This paper will show that the problem is embedded in the way America does health business. The problem needs to be better addressed by both the criminal justice community and the health care industry. Most importantly, those making the health care industry policy decisions need to make a paradigm shift. The system is out of balance because of past policies and decisions that have given excessive power and liberty to the medical services community and insurance providers. Using O’Toole's Compass Card of the four major ideas that have influenced political decision‐making as a guide, this paper recommends that current decision‐making needs to strengthen the equality and community poles and restrict the liberty and efficiency poles so that more balance might exist within the American health care system. Talcott Parsons saw the dangers of commercializing health care over half a century ago. The health care scene of today shows that he was correct in his appraisal.     

What social workers talk about when they talk about child care proceedings in the District Court in Ireland

Court proceedings are a fundamental and increasingly time‐consuming aspect of social work practice. However, to date, there is a relatively modest body of literature considering the experiences of social workers in instituting child care proceedings and giving evidence in court. This paper draws on data gathered as part of an in‐depth qualitative study of professional experiences of District Court child care proceedings in Ireland and presents findings regarding the experiences of social workers in bringing court applications for child protection orders. It seeks to answer 2 key questions: First, how do child protection and welfare social workers experience the adversarial nature of child care proceedings in the District Court? Second, what are the views of child protection and welfare social workers on the strengths and weaknesses of child care proceedings as a decision‐making model for children and young people? The main findings are that social workers expressed significant reservations about the predominantly adversarial model that currently operates in Irish child care proceedings and about the level of respect that social workers are afforded within the operation of the system.     

Consumer‐directed care for older Australians: Are resources identified on the Web adequate to support decisions about home‐based care packages?

Consumer‐directed care (CDC) was introduced as part of aged care policy reforms in Australia in 2012. CDC aims to promote choice and control for people with complex needs who need home care and supports. While more choices may bring benefits, information and resources are needed by people to navigate new and complex care‐related decisions. In 2017, we identified the resources available to support consumers of the new CDC Home Care Packages (HCP) program via an Internet search. Forty‐six resources were analysed to assess the adequacy of information to inform care choices. General information was most frequently found, but information to guide specific choices, such as choosing or changing service providers, was limited. Accessibility of information was limited for non‐English speakers and for people with low literacy or reduced capacity for decision making. No training opportunities were identified, and only one non‐partisan organisation offered support for decision making. Overall, the information and supports analysed were not adequate to assist older people to make choices to ensure consumer direction of care. There is an urgent need to improve the quality and accessibility of information and provide training and support for choice, particularly for those with limited decision‐making capacity, such as those living with dementia.     

Nurturing the virtuous circle: Looked After Children's participation in reviews,a cyclical and relational process

Children's participation in decision making of all kinds is of increasing interest across the world as more and more countries seek to comply with Article 12 of the United Nations Convention on the Rights of the Child. The participation rights of children who are in the care of the state are of particular concern. Recent research in England suggests that Independent Reviewing Officers (IROs) can play a crucial role in ensuring that looked after and accommodated children are able to participate in care planning and review processes. This paper outlines the findings of the first Scottish study to investigate the role of Reviewing Officers in encouraging children's participation in reviews. Surveys were collected from social workers, Reviewing Officers and young people after 69 review meetings as part of an action research study. Follow‐up qualitative interviews were then completed with 10 young people and a focus group held with the five participating Reviewing Officers. The findings suggest that participation in looked after reviews can best be understood as a cyclical and relational process and that taking part in action research may enhance participation practices. While the role of the Reviewing Officer was found to be important, the findings suggest that everyone involved in the care and support of the young person needs to encourage participation processes that are individualized.     

Predicting after-care outcomes: the importance of 'felt' security

Young people who ‘age out of care’ generally do not have the continuing source of emotional, social and financial support that is available to most young people in their transition to early adulthood. They therefore face the challenges of making various transitions with fewer resources and less support, and at an earlier age and in a less graduated way than young people of the same age in the general population. Some, however, manage this process more successfully than others. The current study examines the links between stability, perceived or ‘felt’ security and later outcomes for young people 4–5 years after leaving care. It is based on a four‐wave longitudinal study over 5 years of 47 young people leaving care in New South Wales, Australia. Felt security in care, and continuity and social support beyond care were the main significant predictors of these young people’s outcomes 4–5 years after leaving care. While stability in care was important, this may be as a means to an end–building a sense of security, belonging and a network of social support.     

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.     

Improving decision‐making in care order proceedings: A multijurisdictional study of court decision‐makers' viewpoints

Child welfare removals of children are among the most invasive decisions a state can make toward its citizens, and typically it is the courts that make these decisions. These interventions are regularly exposed to criticism. In this paper, we examine if and how care order proceedings could be improved in England, Finland, Norway, and California, USA. We have asked the judiciary decision‐makers about their view on what should be improved. Our findings show that the organization of the proceedings, including time and staff, are identified as issues in all four systems. Furthermore, the preparations by the child welfare agency are also mentioned as an issue, for English, Finnish, and Californian decision‐makers. Very few decision‐makers indicate features related to the individual, situational, and contextual dimensions, which is interesting since this would be expected from organization theory. The strong call for change in the way proceedings are organized indicates a need for modernization as well as better use of available competency from child development experts. The respondents focus on the elements that a decision‐maker has direct experience with and knowledge about, and this is indeed worth noting for policymakers in the four systems.     

Combining Work and Care: Carers' Decision-making in the Context of Competing Policy Pressures

Issues related to paid work and care are of global importance, reflecting the twin pressures of population ageing and efforts to increase labour market participation. Informal carers of sick, disabled or older people can experience tensions between policies aimed at support for care and support for employment. This article discusses a study of carers’ decision‐making around work and care, drawing on evidence from interviews with 80 working‐age carers in England. Carers are not homogeneous; their circumstances and needs differ reflecting age, gender, ethnicity, labour market participation, and the condition and/or needs of the person they support. This diversity is illustrated by contrasting rural and urban carers’ decisions and experiences about work and care. Key factors that impact on carers’ decisions are: current and anticipated financial need; the constraints arising from receipt of carers’ and other means‐tested income maintenance benefits; personal identity; job opportunities and scope for flexibility; social services provision; carers’ own health. Distance, travel times and transport are unique additional challenges for rural carers who (wish to) work. These difficulties are further intensified when they intersect with other factors such as the Carer's Allowance, the local labour market and social services provision. The findings are evaluated in terms of the adequacy of current government policy measures.     

Delivering decision making support to people with cognitive disability — What has been learned from pilot programs in Australia from 2010 to 2015

The UNCRPD has generated debate about supported decision making as a way to better enable people with cognitive disability to participate in decision making. In Australia, between 2010–2015, a series of projects have piloted various models of delivering decision making support. A critical review was conducted on the program documents and evaluations of these pilot projects. The pilots were small scale, conducted by both statutory and non‐statutory bodies, and adopted similar designs centred on supporting a decision maker/supporter dyad. Primarily, participants were people with mild intellectual disability. Themes included: positive outcomes; uncertain boundaries of decision support; difficulty securing supporters; positive value of program staff and support to supporters; limited experience and low expectations; and varying value of written resources. The lack of depth and rigour of evaluations mean firm conclusions cannot be reached about program logics, costs or outcomes of the pilots. The pilots demonstrate feasibility of providing support for decision making rather than resolving issues involved in delivering support. They suggest that some form of authority may facilitate the role of decision supporters, help to engage others in a person's life, and integrate decision making support across all life domains.     

Age limits for participation in child protection court proceedings in Sweden

According to the UN Convention on the Rights of the Child and Swedish legislation, children have the right to participate in child protection proceedings. The aim of this paper is to describe and analyse the notion of age and maturity in child protection proceedings in order to elucidate how these aspects could influence children's rights to participate. We focus on the view of three groups of actors involved in child protection proceedings in Sweden—social workers, lawyers, and laypersons in social welfare boards and administrative courts—and on how children's age and maturity should be taken into consideration in decisions on their participation in court. The analysis is based on survey data. The study found that social workers, laypersons, and lawyers have different views on when children are old enough to have the right to litigate in court. Additionally, there is no consensus on how the maturity of the child can be assessed to inform the decision about participation. More discussion is needed about what competences a child needs to participate in court and to what extent this right should be limited by their age. Importantly, courts and decision‐making proceedings can be made more child friendly.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.