Paid personal assistance services:an exploratory study of working-age consumers' perspectives

This study examined the experiences of individuals who use paid personal assistance services (PAS). Structured interview data were collected from a convenience sample of 24 working-age individuals from diverse backgrounds recruited from Centers for Independent Living in nine states. Respondents described their general satisfaction with current paid PAS, but many reported previous experiences with poor care related to the low wages, lack of training of PAS providers, and an inadequate supply of providers. Respondents reported many unmet needs because of a shortage of hours provided by state programs and the lack of help with daily living activities, transportation, childcare, and social activities. The respondents strongly preferred consumer-directed care.     

Medicaid State Plan personal care services: trends in programs and policies

Policymakers face mounting pressures from consumer demand and the 1999 Olmstead Supreme Court decision to extend formal (paid) programs that deliver personal care to the elderly, chronically ill, and disabled. Despite this, very little is known about the largest program that delivers personal care: the Medicaid State Plan personal care services (PCS) optional benefit. This paper presents the latest available national program (participant and expenditure) trend data (1999-2002) on the Medicaid PCS benefit and findings from a national survey of eligibility and cost control policies in use on the program. The program trends show that, over the study period, the number of states providing the Medicaid PCS benefit grew by four (from 26 to 30), and national program participation, adjusted for population growth, increased by 27%. However, inflation-adjusted program expenditures per participant declined by 3% between 1999 and 2002. Findings from the policy survey reveal that between 1999 and 2002 there was a marked decline in the range of services provided, and by 2004, almost half the programs operated a cap on the hours of services provided.     

Hospital response to the legalization of abortion in New York State: an analysis of program innovation

The reorientation of hospital services in the state of New York to accommodate women's constitutional right to elective abortion was investigated. Market and resource constraints, the social orientations of the organization, and the values of physicians were examined in the effort to evaluate hospital response between 1971 and 1973. Analysis indicates that program innovation in obstetrical and gynecological services to include elective abortion was inhibited by economic factors that generally determined the feasibility of diverting finite resources to a new service and social orientations and values that determined the compatibility of elective abortions with the dominant values underlying hospital operations. The reform of New York abortion statutes and the subsequent ruling by the Supreme Court reiterating the right of women to terminate pregnancy failed to standardize the delivery of health care so that individual rights to service could be obtained everywhere in the state. The social changes ultimately realized through legislative and judicial action were essentially conditional upon the responsiveness of local health care providers. Legal action that failed to specifically address the administrative role of hospitals in social change qualified local access and could not be completely effective in legitimizing the redefinition of abortion in society.     

The policy context of leaving care services: A case study of Northern Ireland

The transition of foster youth from state care to independent living has received increased research, practice, and policy attention in the United States and in many other countries. Most contributions to this literature have focused on documenting poor outcomes across various dimensions of need in the young people's lives whereas little attention has been given to the policy context in which the responses to those needs are being developed. In this article, we argue that there is a pressing need for better understanding of how the policy context can both promote and impede the development of appropriate services. To illustrate our argument, we use Northern Ireland as a policy case study both because of recent initiatives underway there in regard to youth transitions from state care and because of the heightened political sensibilities associated with it as a society. We draw attention to the socio-political historical context, a number of intersecting social policies, and the place of social work as a key occupation involved in delivering service improvements. We conclude by suggesting that this case study not only highlights the need to address similar aspects of the policy on youth transition from state care in the United States but also demonstrates the benefits of reflecting on policy development and implementation elsewhere in the world.     

Implementation and program evaluation of trauma-informed care training across state child advocacy centers: An exploratory study

Awareness of Trauma-Informed Care (TIC) is essential for all professionals employed at child advocacy centers (CAC). This study evaluated the effectiveness of a training program that utilized a modified version of a TIC curriculum accessible through the National Child Traumatic Stress Network (NCTSN) among CAC workers in Florida. The workers' TIC knowledge level (n = 203) was examined prior to the training, immediately thereafter, and in a 12-month follow-up. Participants in general had similar levels of TIC knowledge before the training although the knowledge level was significantly affected by race/ethnicity, years of working experience, and educational degree. The results also indicated that participants' TIC knowledge significantly increased after training, with an effect size of 0.71. This increase appeared to be universal among participants. Further, the significant increase still maintained in the 12-month follow-up test. The analysis of participants' responses to two open-ended questions suggested that most participants were satisfied with the program. It is suggested that training efforts need to be conducted frequently to ensure that CAC employees get repeated exposure to the information in order to ultimately improve the services they provide to victims.     

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.     

Urban ecosystem management and change during the past millennium: a case study from New York City

Changes in a deciduous forest and salt marsh ecosystem, Hunter Island, New York City, are related to management over the past millennium. Sequential methods, fossil pollen analysis, map and aerial photography series, and vegetation resampling were performed to supplement the historical and archaeological records. The enhanced ecosystem management history provides an expanded context to examine management planning alternatives.Siwanoy native Americans utilized Hunter Island to provide fuel, land for corn planting, and living space through cutting forests in at least the northeast portion of the island. The fossil pollen record indicates that about the time of site abandonment, the Siwanoy planted the forest opening with hickory. Dutch colonial settlers protected forest in the area, but later the island's forest was cut for the British Navy during the American Revolution. John Hunter created a gentleman's farm on the island beginning in 1812.The New York City Parks Department purchased Hunter Island in 1888 and permitted social agencies to clear trees for recreation during the next 46 years. The chestnut blight eliminated American chestnut from the forest in 1908, and at the same time a hickory bark beetle infestation decimated the hickory population. A survey in 1934 showed that the northeast portion of the Island contained a forest, dominated by oak and yellow poplar, and a field. The island became a day-use picnic site in 1943, and for this purpose all the woody plants with stems less than 10 cm in diameter were removed.Aerial photography demonstrated a trend of forest replacing field over the past century. A resurvey of the northeast section of the island in 1988 revealed that oak and yellow popular remained dominant in the old forest, and the field became a hickory and sassafras stand. The hickory dominance, which is typical of Hunter Island, is unusual for New York City forests and could be related to native American plantings over 700 years ago. The management plan for Hunter Island is focused on preservation of the field and forest legacy of the recent recreation period. Instead of preserving an environmental patchwork common in New York City parks, an alternative management focus could enhance the hickory forest component to represent the former native American cultural setting.     

Similarities and differences in program registers: A case study

Researchers, clinicians, and other professionals are increasingly in need of cost-effective, evidence-based programs and practices. However, these individuals may lack the time and, for some, the required expertise to search for and identify such interventions. To address this concern, several online registers that list or categorize programs according to their empirical evidence of effectiveness have been established. Although these registers are designed to simplify the task of selecting evidence-based interventions, the use of distinct review processes and standards by each register creates discrepancies in final program classifications, which can pose a challenge for users. The present case study highlights three programs that have been evaluated by more than one register and have received similar or different classifications. Reasons for inconsistencies are discussed, and several recommendations for evaluating organizations and register users are provided to enhance the functionality and ease of use of online program registers.     

User satisfaction surveys and cognitive question testing in the public sector: the case of personal social services in England

Obtaining feedback from service users is a key element of the UK Labour Government's agenda for modernization of the public sector. This reflects a growing international trend in Europe and North America. Recognized difficulties in taking an approach to performance assessment based on the concept of user satisfaction are outlined. Ascertaining the views of people who use personal social services poses particular challenges which result from the levels of impairment and illness in the population, local variations in service provision and the 'care and control' functions of social care. It is argued that cognitive testing of questions, based on research knowledge about user views, provides a way of overcoming some of the pitfalls of traditional satisfaction surveys, while developing questions that are meaningful to respondents. The origins and principles of cognitive testing are described, followed by an example of their application in the development of a questionnaire for home care users. Strengths and limitations of the approach are identified.     

Measuring outcomes in family support services (a case study using respite care)

Measuring outcomes in family support services is a relatively new area of social research. This study aimed to explore the use of respite care (brief planned periods away from home with the same carers over several months) as a family support service to help prevent long term family breakdown. It studied the service from the perspectives of all those involved in it—social workers, carers, parents and children–and was funded by the UK Department of Health as part of a series of studies commissioned to explore the implementation of the English Children Act law and theory.     

Runaway behavior among adolescents in residential care: The role of personal characteristics,victimization experiences while in care,social climate,and institutional factors

Existing research on runaway behavior among young people in care is severely limited, based mainly on small-scale samples, adult reports and administrative data. The research to date focuses mainly on children's characteristics and pre-care experiences rather than on placement-centered correlates. The present study examines the occurence and multilevel correlates of runaway behavior among Israeli Arab and Jewish adolescents aged 11 to 19 in residential care for at-risk children.     

Crisis nursery services and foster care prevention: An exploratory study

ObjectiveTo examine whether receiving crisis nursery services reduces the chances of subsequent placement of children into foster care.MethodThe study includes a sample of 322 children from the administrative data from a crisis nursery in Ohio. Generalized estimating equations analysis was conducted to assess the relationship between crisis nursery services (case management and parenting education) and subsequent foster care placement.ResultsThe generalized estimating equations analyses indicated that case management and parenting education provided from the crisis nursery were associated with reduced likelihood of subsequent foster care for children who were placed in the crisis nursery. Foster care placement during the previous 12 months and Caucasian race were also associated with higher odds of subsequent foster care placement.ConclusionsCrisis nursery services delivered with case management and parenting education may be an effecive intervention to reduce children's subsequent foster care placement.     

Equity and efficiency in the allocation of the personal social services

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.     

Toward an assessment of the social role of rural midwives and its implication for the family planning program: an Iranian case study

An axiom of family planning programming is the importance of culturally-appropriate communicators and motivators. Traditional midwives seem ideal for this task but few studies have been done to verify this assumption by analyzing the midwife's social role as perceived by the community. 325 married women and 81 unmarried girls from a "model village" near Shiraz were interviewed by female undergraduates. 82.5% of the women are of childbearing age; 66% married before 14 years; 33% use contraception, mostly the pill, but most want large families because they expect high child mortality rates. Most of the older women are able to assist in childbirth but none, except the village's one recognized midwife, who is considered to have divine backing, will do so except in an emergency. The midwife's activities cause her to be held in low esteem by the community because 1) she has contact with a woman's sexual parts and this fact is public; 2) she has contact with vaginal excretia which are, in Islam, polluting; and 3) she is paid for her services, which labels her as a woman "without shame". The midwife is, however, widely used since women and their husbands fear the trip to the hospital and treatment by a male doctor much more than a midwife-supervised birth. The midwife in the study village had been there only 2 years and feels that she is not fully trusted. She is not consulted on birth control at all, because women expect the pill to be dispensed by doctors and consider other methods as a matter strictly between husband and wife. The midwife's role seems to complement that of the government health authorities rather than compete. The midwife's low status and circumscribed sphere of activity, the weak respect in which her advice is held and the pattern of having only 1 recognized midwife in a village at a time make the midwife a poor agent for family planning services. Her effectiveness as an agent of social change could be improved by training her in hygienic practices of childbirth and by redefining her role-relationship with the community. Studies should be done to identify the areas where traditional birth attendants are the best family planning communicators and those where that role is best left to others.     

Change and Inertia in the New York State Medicaid Personal Care Services Program: An Institutional Case Study

This study analyzes how competing logics (belief systems) of stakeholders have influenced patterns of change and inertia in the development of the New York Medicaid Personal Care Services (PCS) program. A case-study methodology was used to collect documents, statistics, and interview data from four key stakeholder groups: state and city officials, PCS agencies, a labor union, and consumer advocates covering the period 1999 to 2005. The New York PCS program is one of the oldest, largest, and most stable programs in the United States. Its early unionization of workers resulted in relatively generous wages and benefits and made New York number one nationally in PCS spending per capita. In spite of wide support from stakeholder groups, the overall number of participants has gradually declined since 1999. A consumer-directed model of personal care developed in 1995 challenged the status quo and has grown steadily. Resistance by public officials, agency providers, and union representatives to the consumer-directed model has resulted in a small program that is often targeted toward individuals labeled “difficult to serve.” Dominant stakeholders in New York have ensured a stable personal care program that has resisted change and led to program inertia.     

Developing the Learning Door: a case study in youth participatory program planning

This article presents the results of a case study in youth participatory program planning conducted in the context of a nonformal technology-education program in eastern Finland. The purpose of the program was to have youth, university, and business stakeholders work together to create the Learning Door, a door that would meet the needs of older people and people with disabilities. The participatory program planning process that was used involved clarifying the mission, roles, and modes of collaboration as well as creating stakeholder matrices, logic models, program plans, and implementation plans. It was found that the observed program planning process was similar to the intended planning process and that the process was well received by the planning participants. The lessons learned include clarifying the nature of collaboration before the program gets underway, reviewing program planning steps often, and making clear distinctions between logic models and implementations plans.