Substance Use Training Experiences and Needs: Findings From a National Survey of Social Care Professionals in England

For more than 30 years there have been calls in the UK to improve training for social workers in relation to substance use. Yet very little research has explored what training practitioners have received or what their training needs are. This study sought to establish practitioners' experiences of previous training in substance use and identify their current training needs. An online survey was disseminated to 3,164 practitioners in adults' (AS) and children's (CS) social care and 12 vignette-based focus groups were also held. Of the final sample of 597, more than a third of social workers had not received any training and a further fifth only received between one and four hours. Other social care staff fared worse. Overwhelmingly, respondents said that substance use knowledge and skills were very important to their practice but their professional education had not prepared them well. They identified a number of training needs including ‘how to talk to people about substance use’ and ‘the types of intervention and treatment available’. Most social care professionals report not being adequately prepared for working with substance use, particularly basic knowledge and skills which would help them to conduct assessments and signpost people to specialist substance services.     

Decision-making around psychotropic medications for children in foster care: Perspectives from foster parents

Background and objectiveChildren in foster care have complex mental health needs and receive high rates of psychotropic medications. Rarely can foster parents make legal decisions about treatment, yet they are intricately involved in the child's life and responsible for the child's safety and well-being. We aimed to conduct the first study of foster parent perspectives on decision-making relevant to the use of psychotropics with children in foster care.MethodsWe conducted semi-structured phone interviews with 13 parents in a small northeastern state who had fostered a child receiving psychotropics in the past 5 years. The state child welfare agency sent information about the study via email to all foster and adoptive parents for whom they had email contact. Interviews queried parents' knowledge and attitudes toward psychotropics, engagement in decisions, and recommendations for the decision-making process. Interview responses were coded and synthesized using mixed inductive and deductive methods in Dedoose software.ResultsChildren came into care on an average of four psychotropics. Parents reported receiving little information about the medications and finding information on their own. Parents acknowledged the potential benefits of medications, yet attitudes were largely against their use. Internal and external pressures for and against the use of medications were described. Many parents felt left out of the decisions and recommended team decisions.ConclusionsEfforts to improve foster parents' knowledge of medications, side effects, and monitoring, as well as team decision protocols, are sorely needed to improve decisions for this population.     

The Self-Care Center for Cuts: A Model for Student Development

Abstract

We conducted a study to determine whether an intervention using self-care information would change college students' attitudes and beliefs concerning personal responsibility and involvement in their own health care. Individuals entering a student health service were randomly assigned to a treatment or control group. Members of the treatment group (n = 187) received the intervention and completed the survey instrument. Members of the control group (n = 204) completed the survey instrument only. The intervention consisted of one page of general information about the benefits to individuals of taking responsibility for their own health and a booklet containing excerpts from a consumer-oriented health care book. The survey instrument was composed of a measure of attitudes toward information and behavioral involvement in health care and a measure of beliefs regarding control over one's health. Results indicated that the intervention was able to change the treatment group's attitudes regarding active participation in health care. The treatment group's responses also reflected less belief that health was outside of the individual's control. The study showed that a positive change in health-related attitudes and beliefs can result from a relatively uncomplicated informational intervention.     

The association between perception of relationship with caregivers and behaviours of youth in foster care: a child and caregiver perspective

The transition into foster care can be difficult for children. Research has consistently shown an increased risk for children in foster care to exhibit higher levels of problem behaviours in comparison to youth in the general population. The purpose of this study was to analyse the associations between the youths' perception of their relationship with their caregiver on their perception of their own internalizing and externalizing behaviours as well as the youths' perception of the relationships with caregivers and how caregivers report of youths' internalizing and externalizing behaviours. This study utilized the secondary data from the general release version of the National Survey of Child and Adolescent Well-Being [National Survey of Child and Adolescent Well-Being (2009) Introduction to the wave 1 general and restricted use releases, Nation Data Archive on Child Abuse and Neglect, Ithaca, NY]. Significant relationships between youths' perception of relationship with their caregiver were found with both youth perception of internalizing behaviours and caregiver perception of internalizing and externalizing behaviours. Results are explained with implications for practice, training, research and policy.     

Family Functioning and Satisfaction of Former Residents of a Non-Therapeutic Residential Care Facility: An Exploratory Study

ABSTRACT

Recently there has been a resurgence in discussions among government policy-makers regarding the use of non-therapeutic residential care as an alternative to kinship and family foster care. If informed decisions are to be made regarding foster care alternatives, evaluation is needed of how children fare in residential care facilities. This study looks at the family relationships and life satisfaction of 76 adults who resided in a residential care facility as children. The overall positive results suggest that the negative reputation of non-therapeutic residential care facilities may not be wholly deserved. The authors hope that this information can assist social workers and policy-makers in making important decisions about the appropriate use of residential care with our country's future population of foster care children.     

The Child Care Arrangements of Preschool-Age Children in Immigrant Families in the United States

This study examined the child care arrangements of children in immigrant families. Using data from the Survey of Income and Program Participation (SIPP), the study found great diversity in the child care arrangements of children according to their nativity status. Children in immigrant families, especially those in low‐income immigrant families, were found less likely to use centre‐based child care. Mexican, Asian, and other Hispanic children are also less likely to use centre‐based child care. Because quality centre‐based child care has been shown to benefit preschool‐age children and help prepare them for school, both scholastically and psychologically, less use of centre‐based child care among children in immigrant families compared to children in non‐immigrant families is a potentially troubling finding. Public policies promoting greater access to and more use of centre‐based child care, especially for low‐income immigrant families and two‐parent immigrant families, may make a significant difference to their children's long‐term adaptation, and their children's school readiness and achievement.     

Financial Exploitation of Older Adults in Rural Settings: A Family Perspective

Federal agencies responsible for funding protective services to older adults are increasingly concerned with the growing incidence of financial exploitation in rural areas. The Wall Street Journal recently has reported an increasing trend of unemployed adult children migrating from urban centers to smaller rural towns and countrysides to live with their parents since 2008. This current study explores the attitudes of family caregivers regarding management of financial matters for their elderly care recipients. The major findings of the study include that adult children often (1) overestimate their parents' ability to manage their finances; (2) prefer to manage their parents' finances informally, as opposed to using legal options like power of attorney; and (3) tend to think of their parents' assets as “almost theirs.” The study concludes with recommendations on the critical need for information to help families make important decisions about helping elderly parents with their finances. This information would not only promote the use of safeguards against abuse, but could potentially provide caregivers with greater confidence and protection.     

Willingness to Use Formal Long-Term Care Services by Korean Elders and Their Primary Caregivers

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.     

Who am I? Who do you think I am? Stability of racial/ethnic self-identification among youth in foster care and concordance with agency categorization

While it has been well documented that racial and ethnic disparities exist for children of color in child welfare, the accuracy of the race and ethnicity information collected by agencies has not been examined, nor has the concordance of this information with youth self-report. This article addresses a major gap in the literature by examining 1) the racial and ethnic self-identification of youth in foster care, and the rate of agreement with child welfare and school categorizations; 2) the level of concordance between different agencies (school and child welfare); and 3) the stability of racial and ethnic self-identification among youth in foster care over time. Results reveal that almost 1 in 5 youth change their racial identification over a one-year period, high rates of discordance exist between the youth self-report of Native American, Hispanic and multiracial youth and how agencies categorize them, and a greater tendency for the child welfare system to classify a youth as White, as compared to school and youth themselves. Information from the study could be used to guide agencies towards a more youth-centered and flexible approach in regard to identifying, reporting and affirming youth's evolving racial and ethnic identity.     

Repeated entries to the Swedish addiction compulsory care system: A national register database study

This study identified and described specific client groups who have repeated entries to the Swedish addiction compulsory care system. Specifically, through the use of baseline data from the Swedish government Staten's Institutions Styrelse (SiS) database, for 2658 individuals who were assessed at their compulsory care intake interview by social workers in the national social welfare system between 2001 and 2009 the study identified the associations between specific predisposing, enabling and need characteristics and repeated addiction compulsory care entries. The logistic regression model identified that individuals whose children have been mandated to the child welfare system, who have experienced prior compulsory care including compulsory treatment through LVU (law (1990:52) with specific provision about care of young people under 18), and those who have been in prison are more likely to have two or more entries in the addiction compulsory care system compared to their counterparts. Individuals who have been mandated to compulsory care for their substance use disorder two or more times have significant multiple complex problems and repeated experiences of institutionalization. These individuals are a group in need of a well-coordinated and integrated system of aftercare services to reduce the likelihood of re-entry into addiction compulsory care.     

Mothers' Differentiation and Depressive Symptoms Among Adult Children

Parents' differentiation has been linked to negative psychological and behavioral outcomes in children, adolescents, and young adults. This line of research, however, has not been extended to families in later life. In this article, we use data from 671 mother‐child dyads in 275 families in the greater Boston area to explore whether mothers' differentiation among their children is related to psychological well‐being among offspring. We examined actual and perceived maternal differentiation in the domains of closeness, expectations for care, and conflict. We hypothesized that depressive symptoms would be higher when mothers differentiated among their children and when adult children perceived differentiation. Although the specific patterns varied somewhat by mothers' and children's reports, the findings indicated that, across all 3 domains, maternal differentiation was related to higher depression scores.     

ASSESSING THE NEEDS OF TRAUMATIZED CHILDREN TO IMPROVE OUTCOMES

This paper is about the development of an outcomes‐based treatment approach in work with traumatized children and of an assessment model to measure progress. In particular, it shows how a spider diagram is used to give a powerful, visual representation of a child's progress. The work described has been carried out by SACCS — an independent UK organization providing treatment based in residential and family settings for children who are severely traumatized by abuse and neglect. This trauma has had a massive impact on their development socially, physically, emotionally, academically and spiritually. The children have complex needs which are extremely difficult to work with. However, the potential for recovery from their injuries remains. I will use a single case study of a child to illustrate the process of assessment and measurement of recovery. The treatment approach used is broadly psychodynamic. The concept of an outcomes‐based approach and the measurement tool described also has widespread relevance in social care.     

Telephone communication with children as part of the self‐care arrangement: A research note

Children in self‐care (latchkey) arrangements have been portrayed as a population at risk, and this has recently led to research investigations, social policy discussions, and legislative proposals. This study examines selected characteristics of mother, child, and family, and the amount of time children spend in self‐care, for their influences on the use of the telephone to communicate with children in self‐care. The analysis builds on earlier studies that indicate the importance of time, child's age, and mother's employment for understanding the growing phenomenon of self‐care. The results of multiple regression analyses are presented and discussed. As expected, the age of the child is the most important variable in predicting the length of time spent in self‐care. The age of the child and the length of time spent in self‐care are the strongest predictors of telephone communication with children in self‐care arrangements.     

The Failed Patient Self-Determination Act and Policy Alternatives for the Right to Die

ABSTRACT

The empirical evidence regarding the implementation and impact of the federal Patient Self-Determination Act is examined in this article. The Act was designed to increase the use of advance medical directives in light of the U.S. Supreme Court's Cruzan decision. Research shows that the law has had little effect and that the use of advance directives has scant relation to medical treatment and care. Various policy alternatives for the right to die are also examined. The authors conclude with an analysis of the likely impact of medical costs, fruitless treatment, and rationed health care on limiting life-prolonging treatment.     

Nearby Nature and Long-Term Care Facility Residents

Abstract

As the population in North America continues to age, long-term care facilities for housing the elderly are likely to become even more important. Because one of the primary foci of these facilities is on sustaining and enhancing quality of life while eventually helping patients and families cope with the dying process, both the physical and social environments are critical to the facilities' success and the users' well-being. Healing, or restorative gardens and other designed green spaces have been suggested by many academics and practitioners as important components of these environments, yet there has been relatively little systematic research on the use and benefits of nature in this context. Do elderly residents of long-term care facilities benefit from access to outdoor areas? What are the design characteristics that are most important for this unique population?

Forty elderly residents of three different urban long-term care facilities were interviewed about the importance of outdoor green spaces and views within the facility, their use of the facility's outdoor spaces, benefits they derive from those spaces, and barriers to using the spaces. Facilities differed both in terms of the amount of nature in their outdoor spaces and in the design of, scale of, and access to those spaces. Results show that overall residents place a high value on access to green spaces and derive a number of benefits from these spaces, yet they spend relatively little time in these settings. Barriers to greater use of outdoor spaces included physical limitations, lack of staff assistance, and design issues. Implications for the value of nature spaces in long-term care facilities are discussed, along with specific design recommendations.     

From Famine to Feast. A Review of the Foster Care Research Literature

Foster care has become the principal placement of choice for children and young people in public care in the United Kingdom (UK). This has been accompanied by a significant growth in its research scrutiny connected to a busy policy agenda, especially since 1997. With its increased usage, fostering has encountered both difficulties and developments. Children often have emotional and behavioural problems which strain their foster families to their limits and risk placement breakdown. Public sector foster carers continue to be in short supply and keeping them engaged in fostering remains a challenge. Major developments have occurred in response to these difficulties. The use of relatives as kinship carers has increased substantially and the non‐governmental or independent fostering sector has grown rapidly. Until comparatively recently, the knowledge base of foster care in Britain was limited, but the past decade has seen that change and now a substantial body of research knowledge is available in the UK. Copyright © 2006 National Children's Bureau.     

The Parent Concerns Questionnaire: evaluation of a mothers' self report instrument for the identification of problems and needs in child and family social work

The measurement of problems and needs is a major issue for policy and practice in social work and social service provision. There has, furthermore, in recent years, been an increasing emphasis on gaining an understanding of users or clients' views of needs and service provision. However, there have been few attempts to develop practitioner and ‘client friendly’ ways of gaining information on problems and needs, either on an individual basis, or through the collection of aggregated data which can be used by local authorities as a whole. Where these have taken place there has been little attempt to assess their reliability or validity. This paper reports on the design and development of the Parent Concerns Questionnaire, an instrument designed to obtain the views of mothers in general, and depressed mothers in particular, in families subject to child and family care intervention. The paper reports on the reliability and validity of this instrument, which is presented as appropriate for use, both with families containing depressed mothers and other families subject to child and family care intervention. It may be used to examine problems and needs both on an individual family‐by‐family basis, and through the aggregation of data, on an authority‐wide basis. Copyright © 2000 John Wiley & Sons, Ltd.