"Many Helping Hands": A Review and Analysis of Long-term Care Policies, Programs, and Practices in Singapore

Using the political economy perspective to examine key long-term care policies and provisions, we uncover some ideological underpinnings of policy-making in Singapore. Family involvement, an inherent part of the long-term care system, is overtly reinforced by legislations and policy imperatives. Further, the government encourages and expects the participation of nonstate actors in the provision of services as part of its Many Helping Hands approach to welfare provision. In our analysis, we argue that the government's emphasis of certain ideology, such as self-reliance and cultural exceptionalism, allows it to adopt a residual and philanthropic approach in support of its macro-economic and legitimacy concerns.     

Deciding to Institutionalize: Caregiving Crisis,Intergenerational Communication,and Uncertainty Management for Elders and Their Children in Shanghai

This phenomenological study integrated crisis theory, social identity theory, and uncertainty management theory to conceptualize the decision-making process around institutionalization among nursing home residents and their children in Shanghai. I conducted face-to-face, semistructured interviews with 12 dyads of matched elders and their children (N = 24). The findings suggest that caregiving crises triggered intergenerational communication about caregiving alternatives and new arrangements, although each generation had different stances and motivations. Children finalized the decision by helping their parents to manage the uncertainties pertaining to institutionalization. This study sheds light on caregiving decision-making dynamics for the increasing aging population across cultures.     

Health care insurance in Japan: Beyond a binary vision of State and family

Despite significant regional diversity in household structures and the existence of community solidarity in Japan, caring for elderly dependent persons has traditionally been considered an exclusively family, and female, responsibility. However, as a result of socio-demographic changes during the second half of the twentieth century, a public system of health care insurance was introduced in 2000. The objective of this development was to "socialize" family and female care activities. This article presents a critical analysis of Japan's health care insurance system and the context that gave rise to its introduction. An important issue is whether the system meets the needs of the elderly and their carers (family and non-family). A further issue is whether the system can take account of regional diversity, diversity in household situations (above and beyond financial concerns), and societal values and beliefs. The article concludes by arguing that demographic ageing presents a societal requirement for the ongoing adjustment of behaviour patterns and living arrangements.     

The concept of family: Perspectives of Spanish young people in foster care

This article employs concepts from family sociology to explore how ‘family’ is conceptualised in 14 life narratives of young people in foster care in Spain. The article draws on a multi-method approach with young people who are in long-term non-kinship foster care. Seven girls and seven boys aged 10 to 22 took part in the study. The empirical material reveals an interplay between biological preference and foster family affective practices in young people's narratives, illuminating a struggle to make sense of the concept of family in foster care. Most of the participants understand family as shared affective practices sustained through love, commitment, consistent care and reciprocity rather than blood ties. Some show a preference for biological connectivity, while others describe family as determined by rituals and family displays. The key practice implications highlight the importance helping young people positioning themselves in birth family relationships, and supporting their sense of family belonging.     

Quality of care: relationship between the perceptions of elderly home care users and their caregivers

The aim was to study the relationship between elderly home care users', and their caregivers', perceptions of the quality of care. The sample consisted of 151 matched elderly home care user-caregiver pairs in a Swedish municipality. The elderly home care users were interviewed and their caregivers filled in questionnaires using an established, theory-based instrument. Results showed that the elderly home care users evaluated most care components more favourably than their caregivers. On ratings of the various care components' subjective importance to the caretaker, the caregivers consistently scored higher than the elderly home care users. Within the subset of elderly home care users who received help at least twice a day, there were greater similarities between caregivers and caretakers. The results are related to comparable research and discussed in terms of caregivers' needs to legitimize their professional identity and actions.     

Family relations, adjustment and well-being in a longitudinal study of children in care

The article reports on a longitudinal study of children placed in a children's home during the first two years of the 1980s. The 26 children placed when younger than 4 years of age and staying more than 4 weeks were followed up 3 and 9 months after leaving the children's home and 5, 10, 15 and 20 years later. The children's family relations, including early attachments and later parental relationships and the perception of who is their family, have been one of the predominant themes in the recurrent studies. None of them had lived with both parents after leaving the children's home and 20 of them had been in foster care for periods or permanently. At the time of the last study the children were young adults, aged 20–25. They are categorized in three rather distinct categories, one for those with a ‘good’ and one for those with a ‘moderate’ social adjustment and well‐being and one for those with a ‘bad’ social adjustment and well‐being insofar as involvement with drugs, criminal behaviour and legal sanctions are concerned. Their contacts and relationships with birth parents and foster parents and the perception of who is their family are analysed by use of attachment theory and developmental psychopathology.     

Exploring the mechanisms explaining the quality of sibling relationships when children are taken into care: A qualitative study of Norwegian children

Sibling relationships are potentially central in children's and young people's lives. Research has shown that the quality of sibling relationships changes in a variety of ways when a sibling(s) moves into care. There is limited understanding of the mechanisms that cause these changes. This study addresses this gap by reanalysing a dataset of 25 semistructured interviews with young people (16 to 23 years) drawn from a municipality in Southern Norway. The original study explored the changes in sibling relationships when the young person moved into care. This reanalysis of the data set explores specifically, using a template analysis, the mechanisms that children describe when exploring why these changes occur. Findings show the intricacies of the young person's social identification with the biological and/or foster family and how sharing a common identity may be key to the development of the sibling relationship when the young person(s) is taken into care. Our findings also show how key adults, such as foster parents and social workers, influence the relationship. The paper concludes with recommendations for social workers on how they may strengthen sibling relationships in families where children have been taken into care.     

‘It's just like another home,just another family,so it's nae different’ Children's voices in kinship care: a research study about the experience of children in kinship care in Scotland

Growing acknowledgement of the importance of the role of kinship carers in caring and supporting children and young people in Scotland has led to a burgeoning of research on this topic. However, most research has tended to focus on the role of kinship carers. A significant gap has been direct studies into the views and experiences of children and young people living with relatives or friends. This paper seeks to address this by drawing on the findings from a small‐scale qualitative collaborative research project with 12 children and young people living in informal and formal kinship care in the Northeast of Scotland. The literature on foster and kinship care is reviewed and key themes identified. The qualitative research data is outlined employing a thematic analysis approach. The key findings are analysed with a view to the potential implications for policy and practice. The paper concludes with proposals for potential future research.     

Home care development in Korea and Germany: The interplay of long-term care and professionalization policies

The aim of the study was to compare the effects of long-term care and professionalization policies on the development of home care infrastructure and the care workforce in reference to long-term care insurance systems adopted in Germany and Korea. A comparative analysis of the effects of the two policy systems allowed us to examine distinct forms of marketized home care service expansion. In both countries, the opening-up of care markets has brought about a significant expansion of home care services through the active participation of mainly for-profit providers. However, a trade-off between the rate of expansion, the quality of care services, and the stability of care infrastructure has emerged. The market-based expansion of home care services has resulted in difficult employment and working conditions for care workers in both countries. The country-specific organization of home care and related professionalization approaches has led to the development of a well-trained care workforce with less precarious conditions in Germany but not in Korea. Despite this difference, less well-trained care workers experience precarious employment in both countries.     

Teenagers in foster care: Issues,themes, and debates from and for practice and policy

The task of fostering adolescents is unique, requiring skills, qualities, and information that acknowledge each young person's particular needs. This editorial summarises a range of research in this special issue covering parenting styles, transitions out of care, child sexual exploitation, and the needs of LGBTQ and separated teenagers. Three themes emerging from the papers are discussed: autonomy and control; risk, resilience, and trauma; and relationships, identity, and stigma.     

Living Close to a Person With Cancer: A Review of the International Literature and Implications for Social Work Practice

To help family caregivers (FCs), social workers need to understand the complexity of FC’s experiences and challenges. For this systematic review, several relevant, multidisciplinary electronic databases were searched. Of 1,643 titles identified, 108 articles met the inclusion criteria and are included in this review. Various experiences, symptoms, and burden related to caregiving responsibilities are described and discussed. The understanding evolving from this study about the FC’s own health risk, caregiver burden, and experiences over time can enhance a social worker’s awareness of an FC’s challenging situation and the potential impact this has on the FC’s ability to provide care to the patient.     

Foster children: a longitudinal study of placements and family relationships

Foster children's family relationships have been one of the themes in a longitudinal study, starting with a disadvantaged group of children, 0–4 years of age when taken into care and placed in a children's home in Sweden. Seven rounds of data collection were carried out; the last two when the children were young adults. This article is about those 20 children in the study group who, in addition to temporary residential care at an early age, have experiences from foster care, either for the remainder of their childhood or before or after a period of reunion. Placement history is put in relation to family relationships, i.e. relationships to birth family and foster family. The categorisation in secure and insecure relationships or attachment patterns is based on interviews with the young adults, with a retrospect of previous relationships. The connection between placement history and family relationship is not obvious in this high-risk group. However, inclusive attitudes from the foster family towards the child's family promote continuity and a sense of security, also in periods of reunion or re-placement, and facilitate foster children's hard work in coming to terms with their family background and finding their own way.     

Courts,care proceedings and outcomes uncertainty: The challenges of achieving and assessing “good outcomes” for children after child protection proceedings

The professed aim of any social welfare or legal intervention in family life is often to bring about “better outcomes for the children.” But there is considerable ambiguity about “outcomes,” and the term is far too often used in far too simplistic a way. This paper draws on empirical research into the outcomes of care proceedings for a randomly selected sample of 616 children in England and Wales, about half starting proceedings in 2009–2010 and the others in 2014–2015. The paper considers the challenges of achieving and assessing “good outcomes” for the children. Outcomes are complex and fluid for all children, whatever the court order. One has to assess the progress of the children in the light of their individual needs and in the context of “normal” child development, and in terms of the legal provisions and policy expectations. A core paradox is that some of the most uncertain outcomes are for children who remain with or return to their parents; yet law and policy require that first consideration is given to this option. Greater transparency about the uncertainty of outcomes is a necessary step towards better understanding the risks and potential benefits of care proceedings.     

Kinship care in the UK: using census data to estimate the extent of formal and informal care by relatives

Until recently, little was known about kinship care in the UK. Research has begun to illuminate the circumstances which lead to children being cared for by relatives, and the stresses and strains experienced by carers. However, most UK research has only considered ‘looked‐after’ children placed with formal approved kinship foster carers, although this group forms the smallest proportion of children in kinship arrangements. In this paper, we use microdata from the 2001 UK Population Census to examine the characteristics of kinship carers and children, and demonstrate that most children in kinship care are growing up in informal unregulated arrangements. Implications for policy and practice are discussed.     

Into adulthood: a follow-up study of 718 young people who were placed in out-of-home care during their teens

In this study, national register data were used to analyse long‐term outcomes at age 25 for around 700 Swedish young people placed in out‐of‐home care during their teens. The sample consisted of 70% of all 13‐ to 16‐year olds who entered out‐of‐home care in 1991. Results revealed a dividing line between young people placed in care for behavioural problems and those placed for other reasons. Young woman and men from the first group had – in comparison with peers who did not enter care – very high rates of premature death, serious involvement in crime, hospitalizations for mental‐health problems, teenage parenthood, self‐support problems and low educational attainment. Young people who were placed for other reasons had better outcomes, but still considerably worse than non‐care peers. Young women tended to do better than young men, regardless of reasons for placement. Very high rates of hospitalizations for mental health problems were found among young people placed for behavioural problems. Breakdown of placement was found to be a robust indicator of poor long‐term prognosis.     

Experienced support from family,school and friends among students in out‐of‐home care in a school‐based community survey

Youth in out‐of‐home care have elevated risks for adverse events and detrimental circumstances possibly affecting their development. Responses from 311 students in out‐of‐home care (OHC) were compared with peers living in birth parent care (BPC) and in single birth parent care (sBPC) in a regional school survey, directed to students in compulsory school eighth year and upper secondary school second year. Results indicate OHC students to experience less satisfaction with friends, leisure time, and families. They state less trust in support from friends and families but a more similar level to teachers, counsellors or nurses. OHC students also express being more exposed to abusive experiences online and perceive less sense of security at home and in school. We conclude that welfare institutions need to recognize the components in building trust and safety for students in OHC and that school and other professional institutions have an important role in serve resilience and promote well‐being for children in OHC.     

Traditional kinship foster care in northern Ghana: the experiences and views of children, carers and adults in Tamale

Surveys were employed to explore the experiences of children in care and their carers about traditional fostering. They also examined the perspectives of randomly selected adults in the community about the practice of traditional foster care in the Tamale area of northern Ghana. The 74 participants responded to closed- and open-ended interview questions about traditional foster care. Frequencies and thematic grouping of qualitative responses showed that the need to keep family ties alive was the key reason for placement of children with family and kin. Majority of the children expressed satisfaction with living in foster care, even though they had experienced physical and emotional abuse and intimidation. Although most carers were not formally employed and had little personal income, they were positive about having the care role, but faced challenges in providing for many children in a difficult economic situation. The report highlights the role of reciprocity, altruistic and socio-cultural factors in quality of care, and the potential for the traditional kinship foster care to provide suitable avenues of placement for children as recommended by the Ghana child rights law. It also identifies the need for education for carers around children's needs and Ghana's child rights law.     

The design and development of an instrument for assessing the quality of partnership between mother and social worker in child and family care

Partnership with parents has become a central feature of child care policy and practice. It is related to a general emphasis on the importance of parents evident in issues such as parental responsibility and family support. As such it would be extremely helpful to have an instrument which provides a measure of the quality of partnership. It would be useful both in individual cases, where it could be used to help strengthen partnerships between social workers and parents, and on a wider basis, providing authorities with data with which to assess, in general, the quality of partnership. This paper reports on the design and development of an instrument for assessing the quality of partnership with mothers. First it focuses on key conceptual elements of partnership, which are considered to be role, and role relationship (of social worker and mother), and power. The paper then identifies key dimensions to the notion of partnership, dimensions which are generally agreed, and relate to the key conceptual elements. The ways these are operationalized are described, and the use of the instrument is analysed. The findings go some way to showing the instrument has both validity and reliability, when considered in the context of practice. It is suggested that this instrument may be used both in research and in practice.