Recent developments in aged care policy in Australia

A series of major reforms implemented through the mid 1980s sought to contain residential care and expand community care in Australia's long-term care system. While this goal has been maintained, a number of new policy initiatives followed the change of federal government in 1996. This article presents a systematic account of current policy objectives, implementation measures, and outcomes in three major policy areas: changing the balance between residential and community care, targeting in community care, and support for family caregivers. This analysis shows that while there have been shifts in emphasis from time to time, concerted policy efforts over the last 20 years have contained the growth of expenditure on long-term care and realized significant change in the service system.     

The use of institutional care for children across europe

This article describes the use and prevalence of institutional or residential care of children in Europe. It looks at systems in Western European countries and in countries of Central and Eastern Europe and discusses some of the difficulties in making comparisons across and within Europe. The author takes a wide view of the available literature, government and non-governmental statistics and case studies across the continent of Europe. Taking account of regional and national variations, he describes two broadly different approaches for children and their families and identifies trends in institutional and non-institutional care in the continent of Europe.

In Western Europe there has been a marked reduction in the use of residential care, accompanied by the development of non-institutional family based care and support services. Whilst there are good child-centred reasons for this shift in provision, some countries have gone too far in reducing residential care and are facing a shortfall in suitable foster carers. The financial costs of both residential and family based services remain high at a time of resource restraints. In the countries of Central and Eastern Europe some family based alternatives to institutional care are emerging, usually within the international non-governmental sector. However, children in out-of-home placements throughout the region continue to enter, and remain in, the same kinds of large, isolated and impersonal institutions that existed before the economic and political changes of the late 1980s.

The writer uses his teaching experience in Romania over the past four years to illustrate the development of small-scale social work initiatives in that country and calls for further developments in legislation and policy to support the practice of the emerging profession of social work.     

Recent Developments in Aged Care Policy in Australia

Summary

A series of major reforms implemented through the mid 1980s sought to contain residential care and expand community care in Australia's long-term care system. While this goal has been maintained, a number of new policy initiatives followed the change of federal government in 1996. This article presents a systematic account of current policy objectives, implementation measures, and outcomes in three major policy areas: changing the balance between residential and community care, targeting in community care, and support for family caregivers. This analysis shows that while there have been shifts in emphasis from time to time, concerted policy efforts over the last 20 years have contained the growth of expenditure on long-term care and realized significant change in the service system.     

The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence: A multi-level meta-analysis

ObjectiveThe outcome of institutional youth care for children is heavily debated. This multilevel meta-analysis aims to address the outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence in economically developed countries. A gain of knowledge in this area may help the decision for referral of children to institutional youth care or other types of care (e.g., foster care or community-based care), and improve outcomes for children in youth care.MethodsOf 19 controlled studies (15.526 participants), 63 effect sizes of behaviour problems (externalizing, internalizing, and total), skills (social and cognitive) and delinquency were computed based on comparisons between institutional Evidence-Based Treatment (EBT), institutional Care As Usual (CAU), non-institutional EBT, and non-institutional CAU.ResultsInstitutional CAU showed a small-to-medium negative significant effect compared to non-institutional CAU (d = − 0.342). Furthermore, children in institutional care showed slightly more delinquent behaviour compared to children in non-institutional care (d = − 0.329). Significant moderating effects were also found for study design, year of publication and sex of the child.ConclusionsChildren receiving non-institutional CAU (mostly foster care) had slightly better outcomes than children in institutional CAU (regular group care). No differences were found between institutional and non-institutional care when institutional treatment was evidence-based. More research is needed on the conditions that make established treatment methods work in institutional care for (young) children.     

Therapeutic alliance between youth and staff in residential group care: Psychometrics of the therapeutic alliance quality scale

Therapeutic alliance has been frequently studied in individual counseling sessions; however, research on therapeutic alliance in residential settings for youth with mental health diagnoses has been limited. This may be due, in part, to the presence of multiple service providers often in caregiving roles. The purpose of this study was to examine the psychometric quality of a widely utilized measure of therapeutic alliance used in psychotherapy with youth in residential care where the treatment is provided by a trained married couple. We also compared the relationship between youth ratings of their male and female service providers, as well as examined correlations in ratings between youth and staff on therapeutic alliance. Finally, we investigated the direction, magnitude, and trajectory of change in therapeutic alliance over a 12-month period following admission into residential care. The method was a longitudinal assessment of 135 youth and 124 staff regarding therapeutic alliance over the course of 12 months or discharge from services. Results indicated strong psychometric properties and high correlations for youth ratings of both their male and female service providers. However, the correlation was low between youth and service provider ratings of alliance. Longitudinal analyses indicated that rates of therapeutic alliance changed over time.     

Marketing ‘madness’: conceptualising service user/survivor biographies in a period of deinstitutionalisation (1975–2014)

This article aims to present the lived experiences of psychiatric service users/survivors who have experienced the transition from institutional care in the 1970s and 1980s to community care services in the 1990s and post-2000s. By using a biographical narrative approach the study compares service users’ historical experiences with their contemporary experiences of community and residential care. Sixteen biographical narratives were analysed to explore how mental health services have changed over time, from the perspective of service users/survivors, their families and mental health practitioners. The study examines how the closure of NHS mental hospitals in the 1980s, which were replaced in the 1990s with new types of community and residential care services, has changed the lives of service users/survivors. Thus, the article presents these lived biographical experiences which, for the majority of service users/survivors, were defined by the process of trans-institutionalisation rather than de-institutionalisation, within a neoliberal context.     

Social images of residential care: How children,youth and residential care institutions are portrayed?

The literature suggests that residential care for children and youth is associated with a negative social image harmful to their wellbeing. However, the social images of children and youth in residential care and of the residential care institutions have received no systematic study. The current study seeks to examine the social images associated with children and youth in residential care and the respective care institutions in Portugal. The sample of 176 participants in the present study was comprised of individuals with and without professional contact with children and youth in residential care. Participants responded to an open-ended questionnaire requesting attributes and characteristics of children and youth living in residential care as well as attributes associated with residential care institutions. The data collected were analysed through Discriminant Analyses, Z Tests and Multiple Correspondence Analyses. Results show that children and youth are primarily described with negative attributes (e.g., sad, rebellious, deprived, lonely) while residential care institutions are mainly described with positive attributes (e.g., cosy, secure, affectionate, comfortable). Results also show that the social images of children and youth in care and the respective care institutions are heterogeneous and present different profiles. Finally, there will be a discussion of the implications of these results for practice, namely the importance of raising awareness about existing biased social images and how to deconstruct them.     

Rediscovering the social question

Neoliberal policies not only privatise formerly public services but also focus one-sidedly on discourses of individual autonomy and responsibility. This makes it difficult to raise ‘the social question’ (the question what constitutes social bonds) publicly since market principles are presented as allowing no alternatives. Social work owes its professional origins however to a shift from early capitalist individualism to policies recognising the need for social reconstruction and cohesion. It was mandated to reconcile the key principles of modernity, personal freedom and equality, although its methodology, often corresponding with social policy regimes, interpreted this mandate variably. Attempts in current social work to adjust to the cancellation of the social question through techniques of ‘activation’ and individualised care further the crisis of the project of modernity which manifests itself in a split between heightened public control measures and privatised concerns for ‘care’, thereby altering its core identity. Reflections on social work's historical position within varying political contexts help to promote a renewed critical examination of the profession's political role and highlight the need to turn interventions at the personal level into occasions that affirm social citizenship, ensure rights and promote social equality.     

Social protection in Chile: Reforms to improve equity

At the beginning of the 1980s, Chile pioneered the implementation in Latin America of structural reforms that fully or partially privatized pensions, health‐care and social assistance systems. Implemented without prior social dialogue, these reforms – which subsequently influenced similar reforms in other countries of the region and elsewhere – led to reduced social solidarity and equity and intensified poverty and inequality. Over the past 18 years, however, democratic governments have corrected many design faults in the original reforms. The author examines the progress achieved and areas of persistent social inequality in terms of coverage, gender balance and funding, and identifies future challenges.     

Managing Risk in Community Care of Older People: Perspectives from the Frontline

Abstract

Since the mid-1980s, Australian governments have focused on expanding community and home-based services for older people. This has led to increased levels of dependency, vulnerability, and complexity to be managed in the community. Consequently, aged care services have had to develop mechanisms for regulating and managing these increased risks, and risk management has become more central to the practices of professional workers in this field. This paper reports on some findings from a large-scale study that explores the way risk management policies have been translated into practice by community-based services in Victoria, Australia. Drawing on interviews with 18 frontline and management professionals employed in community aged care, we found that these workers were wrestling with a diverse and new range of institutional risks beyond those encountered in the actual delivery of frontline care. We found that these workers experienced “risk” in four different contexts, which often created demands for contradictory or conflicting responses. Here we examine these “contexts of risk practice”: professional workers' relationships with their clients, relationships with other service providers, the unregulated nature of the home as a work environment, and community expectations about the management of risk. Despite tensions that frequently arose, workers expressed strong professional commitments to their clients and were motivated to find positive resolutions amid competing interests. We conclude that tensions experienced by workers were embedded in the structural dimensions of institutional relationships and the systematic absence of shared understandings of “acceptable” risks in the community care of older people, rather than in the failure of professional agency.     

Comparison of basic data for the National Survey of Residential Group Care Facilities: 1966-1982

Major findings from this analysis of the data gathered in preparation for the 1966 and 1981 surveys of children's residential group care facilities are as follows below. In the field of residential care of pregnant adolescents, it appears that, despite an increase in the number of births to adolescent mothers since 1966, the preferred mode of serving this population is no longer residential group care. While there has been a small increase (6 facilities) in the number of residential facilities for pregnant adolescents that operate under public auspices, the 49% decrease in facilities under private auspices is the real indicator of the direction of residential services to pregnant adolescents since 1965. In the Child Welfare Stream, the most notable change between 1965 and 1981 was the decrease in the relative proportion of residential group care facilities for dependent, neglected, or abused children and youth. Overall, child welfare facilities accounted for 55% of all residential facilities listed for survey in 1965; in 1981 this percentage had fallen to 37%. As in 1965 the Child Welfare Stream was dominated by the private sector in 1981, with 83% of all child welfare facilities operating under private auspices. This pattern was found for most of the 50 individual states as well. In the Juvenile Justice Stream, the overall increase of 154% in the number of residential facilities since the 1965 listing is due in part to a notable increase in the number of private facilities in this stream of care. Although the majority of juvenile justice facilities are still public, there has been an increase of 17% since 1965 in the proportion of facilities under private auspices. An even greater increase in total number of facilities than was seen in the Juvenile Justice Stream is seen in the mental health field between 1965 and 1981. There were almost four times as many residential mental health facilities listed for survey in 1981 as in 1965. From representing about one-eighth of the total number of all residential group care facilities for children and youth with special problems or needs, the Mental Health Stream increased to a quarter of all such facilities by 1981. As in the earlier study, the Mental Health Stream was dominated by the private sector in 1981. The proportion of mental health facilities under private auspices had increased by 16% since 1965, indicating an even greater involvement of the private sector in the delivery of residential mental health services to children and youth.(ABSTRACT TRUNCATED AT 400 WORDS)     

Barriers and facilitators for access to mental health services by traumatized youth

Polytrauma is a highly prevalent public health problem in the U.S. with even higher rates in urban areas. Children with polytrauma often end up in multiple child-serving systems (e.g., mental health, child welfare, education, juvenile justice) with needs that are both complex and severe. Providers within these child-serving systems have potential to serve as gatekeepers to trauma services by linking youth with trauma-informed treatments and supports that promote recovery. The purpose of our study was to assess the perspective of providers who participated in a nine-month, trauma-informed care (TIC) training intervention on 1) their capacity to make referrals to trauma-specific services following the training, and 2) factors external to the training intervention that supported or hindered their ability to link traumatized youth with services. A subset of sixteen participants from the TIC training completed individual interviews. These participants were predominantly female, African American, and based in the social services sector. The constant comparative method was used to derive three thematic domains related to participant perceptions regarding youth referrals: 1) Organizational and provider capacity to provide trauma treatment or to make referrals to trauma-specific services, 2) Barriers to youth accessing trauma services, and 3) Suggestions for improving coordination of care and referrals. Our study highlights the influence of contextual factors on whether a TIC training can improve the capacity of agencies and individual providers to support traumatized youth in accessing appropriate services. The development of a structure that formally connects youth-serving agencies and providers with specialists trained in addressing traumatized youth is recommended.     

Young people's views of children's rights and advocacy services: a case for ‘caring’ advocacy?

This paper looks at some preliminary findings from research with young people in foster and residential care in the UK who have received advocacy services from a range of local authority and voluntary agencies. The study also includes the views of professionals, from both children's rights and social services. The initial findings highlight the importance to young people of their relationship with rights professionals. They speak about the value to them of care and respect, aspects not always seen as fundamental to rights work. Caring, in its various guises is seen by young people as a vital component of their relationship with children's rights workers. They also see this as important within advocacy work itself since caring about the outcome is often key. A pure individual rights focus with an emphasis on challenge and ‘being heard’ may not take account of the complexity of their situation and may pose difficult dilemmas for young people, especially in dealings with their carers. This ‘caring’ advocacy is not the paternalistic approach of a professional who ‘knows what's best for you’ but is a model based on a strong awareness of ways that young people are excluded and oppressed. It is also about placing a positive value on their contribution as citizens and links to a view of society that gives importance to an ethic of inter‐relationship and care as well as an ethic of individual rights. Copyright © 2007 John Wiley & Sons, Ltd.     

The integration of child care services in Scotland

This paper describes the development of integrated child care services in Scotland with a particular focus on the role of residential child care provision. It discusses changes in Social Work Department policies and the impact this has had on their relationship with the Children's Hearings system. Recent research shows the pattern of use of residential and foster care in three Social Work Departments and issues in the development of residential services are identified. Three particular examples of service integration are described: residential outreach work; a centre for young people under an integrated management; and multi-agency youth strategies. Social work and education services in Scotland are in the process of radical change. In the context of the integration of child care services, the paper discusses the impact of local government reorganisation and changes in child care legislation.     

The system-of-care for homeless youth: perceptions of service providers

Service providers' perceptions of the system of care for homeless youth are described. Face-to-face structured interviews were conducted with staff at homeless youth agencies in Los Angeles County (L.A. County) regarding organizational and staff characteristics, issues affecting youth, types of available services, gaps in services, and barriers to service delivery.Overall, agencies were large, well established, and provided multiple services. Most agencies (62%) were concentrated in Hollywood, a cruise area of L.A. County. Clear distinctions emerged between large and small agencies; large agencies had more resources, more professional staff, were established longer, and were policy advocates. Typical of other US metropolitan areas, services for homeless youth in L.A. County are located in cruise areas, and are not as readily available in other geographic areas. Such geographic barriers to providing a comprehensive and coordinated system of care can affect youth's pathways out of homelessness.     

Forced Migration and Professionalism1

The complexity of forced migration calls for significant expertise with regard to prevention, responses and solutions. This article describes efforts since the early 1980s to professionalize the field. Professional development requires, at a minimum, that three things be in place: training; standards to govern professional competence; and a process for evaluation and improvement. Professional development must take into account the increasing complexity of humanitarian crises; changing notions of sovereinty that permit new solutions; changing mandates and responsibilities of organizations concerned with forced migration; and technological and communications innovations that enable new approaches to forced migration and professional training.     

Understanding Professional Projects in Welfare Service Work: Revival of Old Professionalism?

The professional terms for occupations that provide welfare services are changing, and here the introduction of new public management in the Nordic countries since the 1990s is indicative of wider developments. The article explores professional projects in welfare service work from both conceptual and empirical perspectives. The aim is to produce a gender‐sensitive analysis of the professional projects at the lower levels of the occupational hierarchies in health care. The first part reviews the literature conceptualizing the societal and institutional embeddedness of professional projects. The institutional matrix of welfare states emerges as a key context in shaping the welfare service work performed by women‐dominated professional groups. The second part examines the case of Finland and suggests that recent reforms have created new inequalities in the system of professions, in which occupational groups in welfare service work are becoming marginalized. This signals a move away from ‘democratic professionalism’ towards a revival of ‘old professionalism’.     

Achieving pay equity: Strategic mobilization for substantive equality in Aotearoa New Zealand

In an unprecedented move the New Zealand Government in 2017 announced a $2 billion pay equity settlement for 55,000 healthcare workers in aged and disability residential care and home and community support services. The settlement reversed the Government's previous austerity stance that pay equity for carers was too expensive, and that pay parity in the sector was out of the question. The political concession followed five years of intensive equal pay feminist activism. While pay equity settlements overseas have generally used either legal opportunity structures or government intervention, this article argues it was the combination of complementary and intersecting elements of mobilization that led to the negotiated settlement. These elements include a statutory human rights inquiry; legal opportunity; civil society coalition building; increased women's voice; and a government‐led negotiated settlement. The novel theoretical contribution of this article is its empirical support for the concept of substantive equality.     

Managing risk under the children act 1989: Diversion in child care?

The idea of diversion has dominated the theory and practice of juvenile justice for some time. Developments in child care practice in the 1980s mirror those which produced diversion. Diversion provides an alternative conceptual framework within which the changes to child care law introduced by the Children Act 1989 can be analysed, particularly the interrelation of s.1(5), the so-called non-intervention principle, and Part III, which establishes the duty of local authorities to provide services for children in need. These provisions and current child care practices may be seen to promote four distinct forms of diversion: (1) diversion from court; (2) diversion from care or residential provision; (3) diversion from procedures; and (4) diversion from social work. Examining the law and practice in terms of diversion focuses on the potential gains and losses resulting from the Children Act's emphasis on partnership, planning and bureaucracy without presuming that losses will be compensated for by the provision of services. It also suggests the need to consider child care in terms of net widening and tariff raising.     

Rules or No Rules? Three Strategies for Engagement with Young People in Mandated Services

A qualitative study of 61 youth receiving mandated services (child welfare, mental health, probation) or services where there were no alternatives (residential care for homeless youth) explored worker-client relationships from the perspective of young people themselves. Findings suggest three different but related roles played by workers that successfully engage adolescent clients: (1) “Informal supporters” de-professionalize their role and flatten hierarchies, emphasizing empathy and enforcing few rules; (2) “Administrators” enforce rules that are in the child’s best interest but do so with little emotional engagement; and (3) “Caregivers” who hold reasonable expectations and impose structures but are flexible in their negotiations with youth when rules were broken. While youth spoke most positively about their workers when they acted as informal supporters, a deeper analysis of the data showed that youth also engaged well with workers who enforced rules when those rules were necessary for the child’s safety, applied flexibly, age-appropriate, and fit with cultural norms. Use of all three approaches to youth engagement may help workers create better therapeutic relationships with youth receiving mandated services.