Safer recruitment? Protecting children,improving practice in residential child care

In the wake of a number of high‐profile cases of the abuse of children and young people in residential child care, there have been repeated calls for the improvement of recruitment and selection of residential child care staff. This paper describes the findings from a survey, undertaken in 2005, of operational and human resource managers who have responsibility for the recruitment and selection of residential child care staff in the voluntary and statutory sectors in Scotland. This research was commissioned by the Scottish Executive to identify which elements of safer recruitment procedures had been implemented following the countrywide launch of a Toolkit for Safer Recruitment Practice in 2001. Research findings show that although local authorities were more likely than voluntary organisations to have gone some way toward implementing safer recruitment procedures, the recruitment process lacked rigour and commitment to safer procedures in some organisations. The article discusses the current barriers to the introduction of safer recruitment methods and proposes some possible solutions for the future. Copyright © 2007 John Wiley & Sons, Ltd.     

Demographic Characteristics

This article aims to describe the characteristics of and design elements in gardens/patios at 87 residential living homes for older people and to describe and compare residents’ and staff members’ perceptions of outdoor spaces. The aim was also to investigate factors related to residents' satisfaction with and stays in the garden/patio. The result showed that many gardens/patios had several recommended design elements and, at the same time, obvious deficiencies. The residents (n = 415) valued various aspects of the garden/patio more highly than did the staff (n = 667). Managers responsible for residential living homes for elderly people should take measures to ameliorate deficiencies and deficient elements in design and accessibility that are lacking so that the garden/patio can be used as an important health promotion resource in the care of elderly people. Residents and staff are important actors in such development work.     

The prevailing cultures and staff dynamics in children's homes: implications for training

This paper is about training, and the learning needs of residential child care staff that training should address. It takes as its starting point research that focused on what happens in children's homes, as described by residential staff themselves. It depicts the tasks which staff carry out in relation to their overall goal of benefiting the children and young people in their care, and considers the ways in which staff work to develop and maintain viable and effective teams. Distinctive cultures emerge when working in staff teams, and the paper shows how these are related to the kinds of practice that can be achieved in residential settings. The knowledge base, practice skills, and personal qualities required to work within residential child care are detailed. The paper closes by addressing the implications which this research has for training residential staff to work effectively in group settings. It argues that fundamental to training competent residential staff is a commitment to developing an ongoing culture of learning in workplace settings.     

An Ethnography of an AIDS Hospice: Toward a Theory of Organizational Pastiche

This article describes everyday life at a hospice that provides terminal, residential care to persons with AIDS. Data were gathered over 12 months of participant observation and a series of formal interviews. The hospice is a nonprofit organization that receives most of its financial support from local community churches and agencies. The philosophy of the hospice is common to its genre—that is, care for dying patients should be holistic, personal, and palliative. The hospice staff largely adheres to this philosophy yet also organizes its everyday activities to meet the practical needs of everyone involved. Some of the more interesting staff practices include the use of touch for healing and communicating, and stress management techniques. The essence of everyday life in the hospice, though, is the relationship between the staff member and the resident. The study identifies three types of relationships—caring, pastoral, and intimate. The conclusion focuses on the value of integrating traditional interactionist ethnography and postmodernist social theory for conducting qualitative research on emerging health care phenomena like the AIDS hospice. The concept of organizational pastiche is offered to interpret the distinctive ways health care organizations specializing in HIV/AIDS care must adapt to the unprecedented cultural and biological features of the epidemic.     

Peer violence in adolescent residential care: A qualitative examination of contextual and peer factors

This research examined the way contextual and peer factors influence peer violence in adolescent residential care. One hundred and twenty residents aged 11–21 from 20 residential care facilities participated in 20 focus groups about peer violence in care. The results demonstrated that four, mutually interrelated themes, contributed to explanations of violence amongst residents: 1) residential peer culture; 2) vulnerability at the beginning of institutionalization; 3) deprivation, stigmatization and frustration; and 4) poor relationship with staff. The results are discussed with reference to the existing residential care and prison-based research on bullying and peer violence and a number of research and policy recommendations are provided.     

Child Abuse on the Internet: Ending the Silence

The Melbourne Health (MH) Social Work Residential Care Team (RCT) was established in 2002 as a new and innovative approach to aged care. The service employs three full-time social workers and an Allied Health assistant with previous experience in aged care. The RCT works across the MH continuum of care with inpatients recommended for residential care. The service is predominantly patient- and family-focused, but is also consultative to meet the education needs of MH staff and the community. This paper discusses the MH Social Work Residential Care model, reviews data collected since RCT implementation and the benefits shown for patients, their families and interdisciplinary staff. This paper discusses pressures and factors that impinge on the ability to discharge patients to residential care and explores recommendations for ongoing clinical practice as well as recommendations that the RCT has submitted to management for further consideration.     

Scandalous Care: Interpreting Public Enquiry Reports of Scandals in Residential Care

ABSTRACT

This article reviews an earlier study written for the Wagner Committee (1988) on scandals in residential care. That review was based on a study of ten enquiry reports, only two of which were about homes for older people. The main events that were described are grouped as: institutionalised practices, indifference and neglect, physical cruelty, humiliation, too authoritarian a life-style, a dull and depressing life-style, an overcrowded and run down environment, disharmony amongst the staff team, and staff misappropriating goods or money. Now, more weight should be given to: residents' abuse of residents and of staff, an improper influence on the life-style of others, and sexual abuse. Explanations proposed are: structural, environmental, and individual and worker style. Abuse is considered in the context of the nature of direct care and the acts of intimate caring of others.     

To be or not to be a rights holder: Direct and indirect effects of perceived rights on psychological adjustment through group identification in care

This study explores how young people in residential care perceive their rights and the relationship with their adjustment, through the role of group identification. Data from a non-random sample of young people (N = 356; aged 11–18 years) in Portuguese residential settings was analysed and a set of mediation effects was found. Findings revealed a set of mediation effects on the relationship between Participation and Protection and Positive Self and between Respectful system practices and behaviours and Emotional Distress, Anger Control and Antisocial Behaviour. Higher scores of these rights perceptions were associated with lower psychological problems, through the indirect effect of group identification (i.e., the sense of belonging to the group in residential care). These findings are discussed based on social and developmental insights together with empirical evidence on residential care. These results provided important practical implications in residential care, namely, assuring the young people's participation, the promotion of professional practices based on the respect for young people and their families, non-discriminatory behaviours and equal opportunities.     

Staff responses to age‐related health changes in people with an intellectual disability in group homes

The purpose of this study was to explore how supervisors in group homes caring for people with intellectual disability responded to the development of age‐related health changes in their residents. Ten group home supervisors working in the disability sector were interviewed once. Data were analysed using Dimensional Analysis. The study identified several factors related to whether a resident could stay ‘at home’ or would need to be moved to residential aged care (nursing home) including: nature and extent of group home resources, group home staff comfort with residents’ health changes, staff skill at navigating the intersection between the disability and ageing sectors, and the supervisor’s philosophy of care. The ability of older people with an intellectual disability to ‘age in place’ is affected by staff knowledge about and comfort with age‐related illnesses, staff skills at navigating formal services, staffing flexibility, and the philosophy of group home supervisors. Despite the growing international concern for the rights of people with disability, particularly in relation to decision making, questions about the older person’s choice of residence and participation in decision making about what was best for them, were almost nonexistent. Rather, decisions were made based on what was considered to be in ‘the best interest’.     

Future expectations of adolescents in residential care in Israel

The study examines the future expectations of adolescents in residential care facilities in Israel and their worries about the pending transition to independent living. The study examines the hypotheses that personal variables (e.g., gender, a personality trait of optimism) and social support variables (the support of family, peers and staff) predict their future expectations. 277 adolescents participated in the study. The self report questionnaire covered several areas including demographic background, optimism, family, peer and staff support, readiness to leave care and future expectations. Results indicate that most adolescents perceived their future positively. The most positive expectations were in the family and friends domains. About a third of the adolescents were worried or very worried about leaving care. Worries were not related to gender. Optimism, social support by mother and peers (but not staff) was positively correlated with future expectations. The findings suggest that there are areas of concern that should be addressed through programs to prepare youth for leaving care. Follow up and longitudinal studies are suggested.     

Culturally Competent Substance Abuse Treatment for Asian/Pacific Islander Women

Summary

In response to the urgent need for substance abuse treatment among pregnant and postpartum Asian/Pacific Islander (A/PI) women, heath care and social service providers in a rural community of Hawaii established a culturally based, women-centered residential treatment program. The program was designed to address barriers that often prevent A/PI women from engaging and completing treatment. Treatment included Hawaiian healing practices or deep cultural therapy, provision for newborns to live with their mothers, infant health-care services, parent education, and infant-mother bonding guided by kupu-na (elders) of the community.

Analysis of twenty-one in-depth interviews revealed factors that A/ PI women participants found vital to their treatment process: having their children with them in a non-punitive, mutually respectful treatment milieu; working with consistent, competent residential staff and culturally-sensitive interdisciplinary professionals; and involvement in a range of substance abuse interventions, including cultural healing practices.

Findings underscore the importance of learning about and affirming women's lived-experiences and cultural contexts in the development of culturally competent practice models, interventions, research procedures, and policies that focus on the complex needs of chemically dependent pregnant and parenting women (Brindis & Theidon, 1997).     

Dementia Patients’ Transition to Residential Aged Care: Carers’ and Social Workers’ Experiences

Many people with dementia eventually require residential aged care, frequently preceded by a hospital admission. Family carers often find the process challenging and disempowering, as they are expected to move their family member to residential aged care quickly. This article reports on findings from a small Australian qualitative study focusing on the provision of information, support and resources, and discusses the findings in relation to person-centred care and critical social work. Social workers completed an online survey and participated in focus groups, and carers were interviewed. The research found that carers valued the information, support, and resources provided by social workers and other hospital staff. They needed time to adjust to the dementia diagnosis and wanted a supportive person to talk to about the written information. The social workers wanted an improved approach to the preparation and communication of information, and a more consistent approach to family meetings.     

Staff and youth views on autonomy and emancipation from residential care: A participatory research study

The use of participatory approaches in designing services is still relatively uncommon. In this study, we helped design a service to support the transition of youth from residential care to independent living by exploring the perspectives of staff and of youth regarding: (a) the concept and development of autonomy; and (b) key factors in developing this type of service. We gathered the data through 10 interviews with staff (n = 10) and 4 focus groups with youth (n = 21), and subjected the data to a thematic content analysis. Staff defined autonomy as self-regulation and self-care, and identified three paths to foster autonomy – a sense of normality, meaningful relationships, and planning for emancipation. The staff and youth identified the following important aspects in designing the service: achieving normality (e.g. limited number of residents), promoting youth capacity (e.g. skill-building activities), providing social support (e.g. trust and respect between residents), and assuring guidance and boundaries (e.g. supervision of youth).     

Residential Child Care Agencies as Learning Organisations: Innovation and Learning from Mistakes

The residential child care sector has been scrutinised via numerous inquiries following revelations of abusive and poor practice. These inquiries have made numerous recommendations which involve changes in practice and organisational culture, much of which is congruent with the features of a learning organisation. This article details research which evaluates the extent to which residential child care agencies exhibit the characteristics of a learning organisation. The research involved qualitative and quantitative methods, drawing on the experiences of a range of staff from the residential child care sector within Scotland. The findings revealed that residential child care agencies exhibit many features of a learning organisation, yet the extent to which these characteristics are perceived to exist differs significantly in line with the position staff occupy. Most significant were the findings that many staff do not feel supported to take risks nor encouraged to develop innovative practice; mistakes are not used as learning opportunities and a culture of blame is felt to exist. The implications of this are significant and this article identifies changes necessary to allow residential child care agencies to operate as learning organisations.     

Managing the process of change in residential child care: A consultancy approach

This article explores the impact of a consultancy undertaken with groups of residential child care staff within a large local authority who were experiencing considerable changes in their working environment as a result of a review of residential care structures. The authors were invited to engage directly with staff on an individual and group basis to help them work through the barriers they perceived to changing their approach to practice. The theoretical underpinning for the work was Charles Handy's [1993, Understanding Organisations (Harmondsworth, Penguin)] belief that change is more likely to have a positive outcome when staff have an investment in and contribution to the change processes. The model of change utilised within the sessions with staff was Kurt Lewin's three stages of 'unfreezing', 'change' and 'refreezing'. The consultancy raised a number of issues about the process of change and how this can be achieved within the residential child care context. In particular, it highlighted the problems of assuming that change is a linear process which can be directly controlled and managed in the flux and uncertainty which characterises this sector.     

A place to heal: a qualitative focus group study of respite care preferences among individuals experiencing homelessness*

Homeless patients have longer hospital stays than housed persons due, in part, to a lack of safe discharge locations. Respite care for homeless individuals decreases hospital length of stay and readmissions rates. This study aimed to develop client-centered recommendations for medical respite care. We conducted four focus group interviews (n?=?25 participants) between August 2010 and February 2013 of homeless adult residents in Minnesota. Four domains of respite care were identified from content analysis of interviews: physical, relational, facilitation, and amenities. Novel recommendations include (a) a facility equipped to address mental health and substance dependence needs, (b) a standardized training protocol for respite staff, (c) the creation of a patient advocate, and (d) the creation of a respite case manager to facilitate post-discharge instructions and connection to primary care and social services. These new and actionable recommendations could help inform policies and the development of future medical respite care facilities.     

In between formal and informal: Staff and youth relationships in care and after leaving care

This paper deals with the contact and relationship youth have with staff while in care and after emancipation and examines the young adults' needs in contacting staff after leaving care. The study was conducted through 60 interviews with young adults ages 21–26 who emancipated from residential settings in Israel. Results showed that most youth report having had a meaningful staff member in care and that 62% were in contact with staff after their transition to independent living for both emotional and practical needs that could not always be answered by staff. One of the study's conclusions is that despite their departure staff's relationship with these young adults continues informally years after. However, without formal recognition of the place staff have in the lives of aged-out youth, no resources are invested in training them to properly meet the young adults' needs. The discussion highlights the need for an integrative approach that sees residential settings and staff as a meaningful part in the continuity from care to independent living by supporting aged-out youth's gradual transition to adult life.     

‘IT'S TIME IT ENDED AND YET I HESITATE,I HESITATE TO END IT’: THE EMOTIONAL WORLD OF AN OLD PEOPLE'S HOME

Institutionalized responses to human care have been prone to developing unhelpful practices. Inquiries into malpractice often generate recommendations focusing on improving protocols or procedures, while neglecting the emotional experiences of both clients and staff. In this study, we aimed to address why and how complex and challenging emotions enter into care work. We explored the emotional world of a residential home for older people, using a psychosocial observational approach based on the Tavistock method. We have presented four themes: attacking–defending, living–dying, paralysis–movement and emptiness–fullness, which illustrate the complex existential challenges faced both by residents and staff in such a context. Our observations revealed how a range of defensive processes operated to protect the observer from experiencing painful feelings and emotions. Throughout the observation period an increasingly complex understanding developed of the emotional life of the home. This process was made possible by reflective supervision sessions. Our findings generate implications for the type of support that may be needed by care staff in such environments.