A culture of education: Enhancing school performance of youth living in residential group care in Ontario

This article presents a synthesis of what is known about the educational experiences of youth living in residential group care based on a literature review that highlights both the experiences of the youth themselves and the operational context of residential group care in Ontario as it pertains to educational performance. The author argues that there is little emphasis on education within the residential group care sector in Ontario that could translate into more productive educational experiences for youth. The article then provides a framework for developing a culture of education for residential group care that can be acted upon expeditiously. Enhancing the educational performance of young people living in group care will require a cultural approach that provides for daily and pervasive education supports and encouragement, and aims to enhance the lived experience of young people pursuant to their education.     

Specialized foster care and group home care: Similarities and differences in the characteristics of children in care

Until recently, foster children who presented special medical or behavioral problems were largely served in group care environments. Specialized (or “treatment”) foster care has recently been developed to serve some of these challenging children. Although growing evidence points to the special needs of children in foster care, much is still unknown about how children placed in various out-of-home care settings differ from one another. The growth of specialized foster care as an alternative placement to group care, calls for examination of how children in these settings compare on demographic, educational, health, and behavioral characteristics. A cross-sectional mailed survey was distributed to all group care and specialized foster care agencies in a large state to address topics related to children's characteristics. Comparisons point to two groups of very difficult children, with unique mental health and health needs.     

“I want to be there when he graduates:” Foster parents show higher levels of commitment than group care providers

Group care is a frequent placement for adolescents placed in out of home care when their birth parents' care is deemed unsafe. In the present study, we assessed whether foster parents show greater commitment to children than group care providers. Given that group care represents a number of living arrangements, we considered both shift care (where staff work shifts and do not live with the children) and cottage care (where staff live for extended periods of time with the children in a group living context). Commitment was assessed using the This Is My Child Interview (adapted for adolescents). Thirty-one foster parents, 18 shift workers, and 28 cottage care providers were interviewed. As predicted, foster parents showed higher levels of commitment than both shift care workers and cottage care providers, and the associations held when children's externalizing behaviors and the number of children the caregivers had cared for were controlled. The results suggest that foster care promotes greater commitment among caregivers than other out of home placements, and add to other findings that favor foster care as the out of home placement of choice for adolescents.     

Comparing the health status of low-income children in and out of foster care

Children in foster care face poverty, family dysfunction, neglect, and abuse, with high rates of chronic health, emotional, and developmental problems. This study compared the overall health status of a group of children entering foster care with a group of Medicaid-eligible children living with their parents, matched for age and gender. It identified significantly more health and developmental problems in children in foster care than in the comparison group. Possible contributors to the higher percentage of problems among foster care children may be that the foster children have more problems related to the underlying risk factors resulting in placement, or that the foster care physicians conducted a more comprehensive assessment or had lower clinical thresholds. Further research is necessary to identify and treat the problems of this high-risk group.     

A Literature Review Comparing the Outcomes of Residential Group Care and Therapeutic Foster Care

Both advocates of residential group care and therapeutic foster care claim that their programs serve the most troubled children and youth. Prior research, often limited to single sites and small numbers of subjects, have not confirmed such claims. The authors describe the evidence regarding these claims, the research literature pertaining to program effectiveness, and a means for empirically evaluating the impact of residential group care and therapeutic foster care.     

Family-centered group care

Alternate frameworks for a model of residential group care focused on the family have the primary objective of early discharge from group care. The proposals are based on an agency's experience.     

Student units for practice teaching in group care

In this paper, an attempt is made to summarize the British position with regard to the use of student units in social work education. The strengths and limitations associated with student units are evaluated with respect to a practice curriculum for people intending to work in the group care field (institutional care, residential group living and day services). Finally, four different models of student unit are identified in such a way as to show how supervised experience could be organised to improve training for group care practice.     

Latent classes of older foster youth: Prospective associations with outcomes and exits from the foster care system during the transition to adulthood

Youth in the foster care system face considerable challenges during the transition to adulthood. However, there is significant variability within this population. This study uses person-oriented methods and a longitudinal dataset of youth aging out of foster care to examine differences in how subgroups of foster youth fare during the transition to adulthood. We identified four distinct latent classes, consistent with prior person-oriented studies of this population, and validated these classes by examining differences on additional relevant factors at age 17. After establishing these classes, we tested their predictive validity by examining differences in outcomes at age 19 in domains relevant to the transition to adulthood, including education and employment, problem behaviors, and mental health problems. Finally, given the importance of extended foster care in promoting better outcomes, we used survival analysis to prospectively examine whether class membership was associated with differences in the rates at which youth left foster care between ages 17 and 19. One large group of youth exhibited moderate behavior problems and left care quickly, while another large group of resilient youth had favorable outcomes and left care relatively slowly. A small group exhibited considerable behavior and mental health problems, but left care more slowly, and a very small group was characterized by a history of pregnancy. Findings suggest considerable variability in service need among older foster youth. Implications for service provision during the transition to adulthood are discussed.     

The Inside Out? Views of Young People,Parents, and Professionals Regarding Successful Secure Residential Care

Although adolescents often seem to improve in their functioning during residential care, there still is little knowledge on what factors are important in achieving these changes. The present study aims to identify the care factors that are important for adolescents’ behavior change during secure residential care. We conducted in-depth interviews with eight adolescents, their parents, eight group care workers and seven teachers concerning their in-care experiences. Both adolescents and parents commonly attributed changes during secure residential care to the treatment environment. Group care workers and teachers did not have a clear, consistent view on the treatment aspects causing positive change with the adolescents. According to the adolescents, good professionals apply a fine balance between rules and freedom, show empathy and are available for support. The view of parents corresponds to this image. Although group care workers are perceived as available for support, adolescents tend to make little use of this help if they experience personal problems during care. The results highlight the importance of responsiveness of secure residential care professionals to the needs and perspectives of adolescents and parents.     

A comparison of outcomes for children and youth in foster and residential group care across agencies

Working collaboratively with two state associations and their member (nonprofit) agencies providing out-of-home care to children and youth, University researchers conducted a multi-site project to examine whether there were any differences in individual child-level outcomes between children placed in residential group care and those placed in foster. The study employed a quasi-experimental repeated measures design, with data collected at a minimum of two intervals (at intake and 3-month follow-up) and at subsequent intervals of 6 and 12 months for children remaining in care. Samples for analyses were drawn from 1082 youth in either residential group care (n = 903) or foster care (n = 179), in one of 37 agency sites across two southeastern states, who participated in a broader evaluation project. The average ages of participating youth in residential and foster care were 13.97 (SD = 2.43) and 13.65 (SD = 2.73), respectively. Based on his or her score on the Children's Global Assessment Scale (CGAS) at intake, each participant was also assigned to the low functioning group (n = 526; 53.1%), the borderline group (n = 232; 23.4%), or the high functioning group (n = 232; 23.4%). Analyses confirmed that youth in foster care tended to have higher levels of general functioning at baseline than did youth placed in group care. However, the degree to which youth progressed in care on measures of general functioning and mental and behavioral health problems did not differ based on placement setting; youth in residential group care settings progressed at the same rate as youth in community-based settings, regardless of their level of functioning at intake. The only exception to this pattern was in regard to anxiety; there was an observable, but non-significant trend of youth in foster care reporting decreases in anxiety levels, while those in group care reported increased anxiety.     

Developmental outcomes among Korean adolescents in out-of-home care: A longitudinal study comparing kinship foster care and institutional care

Kinship foster care has recently become the new main form of Korean out-of-home care, and has reached similar usage proportions as the more traditional form, institutional care. To compare the effectiveness of the two care types, we focused on adolescents' developmental outcomes. We also examined changes over time in the outcomes and group differences in the changes. We analyzed five-year longitudinal data from 244 adolescents who participated in the Panel Study on Korean Children in Out-of-Home Care. A repeated measures Analysis of Variance (ANOVA) was used as the major analytic method. The study results revealed that the kinship group was better off at the baseline for covariates than was the institution group for almost every development measure. However, the group differences observed at baseline disappeared or reversed in direction, which indicated better longitudinal outcomes for the institution group. In terms of changes over time, self-esteem and delinquency of all adolescents, no matter to which group they belong, changed in a positive way. However, there were no group differences in the patterns of changes. Based on these results, we discuss the limitations of the Korean out-of-home care system, such as the lack of assessment and monitoring, and support for kin caregivers.Ethical approvalWe obtained informed consent from the participating adolescents and Sookmyung Women's University IRB (the first through the third wave panel research) and Ewha Womans University IRB (the fourth and the fifth wave) approval before we began this research.     

Quality of care for youths in group homes

This paper analyzes findings pertaining to quality of care issues concerning group home care for adolescents in the greater Los Angeles County area during 1978-1979. The issues include normalization, institutionalization, treatment goals, continuity of care, and qualifications of child welfare staff, particularly child care workers. Recommendations for improvement are offered.     

Reforming the health care delivery system

The health care delivery system is evolving rapidly. There have been changes in the way health care is financed, the types of treatments available, the sites of care, and the physician patient relationship. These changes have resulted primarily from reactions to health care cost inflation. Health care reform is likely to accelerate some of these changes. The threat/promise of health care reform has already accelerated the consolidation of the health care services market. Health care reform is likely to reduce the number of insurers, increase the number of Americans in managed health care plans, increase the number of physicians in group practice, change provider income, and in general make the health care delivery system more concentrated and vertically integrated.     

Core strategies,social processes,and contextual influences of early phases of implementation and statewide scale-up of group prenatal care in South Carolina

This mixed-methods process evaluation examined a state-wide, interagency collaborative in South Carolina that expanded CenteringPregnancy group prenatal care from two to five additional healthcare practices from 2012 to 2015. The evaluation focused on delineating core processes, strategies, and external contextual elements of group prenatal care implementation and scale-up. Success of this scale-up was enhanced by the effective use and creation of windows of opportunity, which allowed stakeholders to pursue actions consistent with their own values, at both state and organizational levels. Most importantly, strong political advocacy and state-level financial commitment for group prenatal care made it possible for clinics throughout South Carolina to begin providing CenteringPregnancy to their patients. Improved understanding of the processes involved in scaling-up pilot interventions may enhance the effectiveness and efficiency of future expansion efforts.     

Temporary care foster parents: Motives and issues of separation and loss

Temporary care foster parents, that is, foster parents who specialize in the care of infants, provide an invaluable service to child welfare agencies. They are a unique group among foster parents, and it is important to understand what motivates them to care exclusively for infants. In infant care, separation and loss experiences are repeated more often than in any other kind of foster care. The article identifies five motives most often seen in temporary care foster parents and explores as well the impact of repeatel separation and loss on the foster family. Implications for practice are suggested.     

The contribution of a cultural perspective in understanding and evaluating client satisfaction

Increasing attention is being given to including measures of client satisfaction as a component in the evaluation of health care services. An understanding of cultural factors that may influence attitudes and behaviors in the health care situation can contribute to the theory and measurement of client satisfaction. Through an examination of some of the cross-cultural literature, this paper delineates dimensions of the health care situation in which clients have been shown to have distinctive preferences, behavioral patterns, attitudes, and treatment expectations. A knowledge of the beliefs and attitudes concerning health and illness that are espoused by a particular cultural group can be a valuable asset in understanding how members of that group will evaluate the delivery of health care services. The examination of how cultural and ethnic differences may affect client satisfaction outcomes points to the necessity of avoiding a global measure of client satisfaction without first examining those particular aspects of health care delivery and of the measurement context that may have a predictable influence on client satisfaction ratings.     

Green Care Farms Promote Activity Among Elderly People With Dementia

In the Netherlands, an increasing number of green care farms are providing day care to community-dwelling elderly people with dementia. Currently, it is unknown whether activities, activity participation, and facility use of elderly people with dementia at green care farms differ from those at regular day care facilities. The authors performed group and individual observations at 11 green care farms and 12 regular day care facilities. Activities of elderly people at green care farms were more frequent, occurred outdoors more often, were of a higher physical intensity, and more often were aimed at individuals than activities at regular day care facilities. Therefore, the green care farms’ environment may be more beneficial for elderly people with dementia than the regular day care facility environment.     

The heterogeneity of children and their experiences in kinship care

Increasingly, children in need of out-of-home care are being placed in kinship care, yet few studies have followed their placement histories longitudinally to determine if these children constitute a homogeneous group or heterogeneous subgroups. This study of 484 children in kinship care in San Diego County, California, indicates that children in kinship care have markedly different sociodemographic and maltreatment histories, as well as heterogeneous placement experiences.     

Interventions to prevent needle stick injuries among health care workers

Needle stick injuries (NSIs) are frequently reported as occupational injuries among health care workers. The health effects of a NSI can be significant when blood-to-blood contact occurs from patient to health care worker. The objective of this study was to evaluate whether the number of NSIs decreased among health care workers at risk in one Dutch academic hospital after introduction of injection needles with safety devices in combination with an interactive workshop. In a cluster three-armed randomized controlled trial, 23 hospital divisions (n=796 health care workers) were randomly assigned to a group that was subjected to the use of a 'safety device plus workshop', to a group that was subjected to a 'workshop only' or to a control group with no intervention. The combined intervention of the introduction of needle safety devices and an interactive workshop led to the highest reduction in the number of self-reported NSIs compared to a workshop alone or no intervention. For practice, the use of relatively simple protective needle safety devices and interactive communication are effective measures for reducing NSI's.