Therapeutic residential care in Spain. Population treated and therapeutic coverage

Therapeutic residential care (TRC) is the name given to specialized children's homes for treating cases with severe emotional and behavioural problems that have been placed in residential care. A recent international review has revealed great diversity in the referral criteria of cases and in the models of intervention carried out. The goal of this study is to describe the population treated in these types of facilities in Spain and the therapeutic coverage given. The sample is made up of 215 young people in children's homes, of whom 93 are in TRC. The cases referred to TRC have been in residential care for less time but have gone through a greater number of placements. These young people also exhibit more problems of drug use, and there is a larger percentage of clinical‐range cases in the Child Behaviour Checklist scales of attention problems and aggressive behaviour. Nevertheless, the results of logistic regression indicate that the only variables that significantly increase the probability of being referred to TRC are drug use and changes of care placements. With regard to therapeutic care, there is a higher percentage in the TRC group receiving psychiatric care, and the sessions are also more frequent.     

Residential care: an effective response to out‐of‐home children and young people?

The ever‐growing number of out‐of‐home children in Italy over the last decade has urged an assessment of the available care services. Although foster care is spreading rapidly, many young people are still housed in residential facilities. Reflection on residential care quality has intensified at both a national and an international level. This paper presents the results of a study on residential care facilities for children and young people in the region of Northern Italy (Lombardy). Four dimensions of ‘quality’ are considered: efficiency, effectiveness, participation in planning and intervention, and empowerment of children and their family relationships. The combined effects of these dimensions are defined as ‘relational quality’. The results show that residential care facilities are generally good, while Social Services resources often appear inadequate for interventions aimed at birth families (efficiency). The well‐being of children in residential care facilities is high, even if they tend to move from one facility to another, rarely returning to their birth family (effectiveness). The involvement of children and their families at different stages of the care path is limited (participative approach). Finally, the most critical element is the failure to properly involve birth families (empowerment).     

Commercial,non‐profit and governmental residential elderly care in Flanders: Differences in client selection and efficiency?

Verschuere B, Moray N, Decramer A. Commercial, non‐profit and governmental residential elderly care in Flanders: differences in client selection and efficiency? Inspired by New Public Management, governments have stimulated competition, outsourcing and privatisation in the public sector. Also, in care of the elderly, there has been a substantial increase in commercial provision. The present study explored the presumed differences in the performance of public (governmental), private non‐profit and private commercial elderly care organisations. We used quantitative indicators on the population of residential elderly care organisations in Flanders (Belgium). Although we found that commercial elderly care facilities tended to be more input‐efficient while non‐profit and public elderly care facilities tended to be more attentive to recruiting and housing residents with high care needs, these results need to be interpreted in light of the regulatory framework in which the different types of elderly care facilities operate.     

From Person-Centered to Relational Care: Expanding the Focus in Residential Care Facilities

Long-term residential care facilities for older adults currently espouse a philosophy of person-centered care (PCC). However, these facilities operate according to a medical model with highly structured administration and regulation. As a result, there is tension between the priorities of the resident and the organization. A qualitative study conducted with 4 social workers and 1 physician employed in residential care facilities demonstrates not only the structural barriers to PCC, but also the importance of meaningful relationships to residents' socio-emotional well-being. The final section explores how organizational barriers might be mitigated through the complementary use of relational care.     

From person-centered to relational care: expanding the focus in residential care facilities

Long-term residential care facilities for older adults currently espouse a philosophy of person-centered care (PCC). However, these facilities operate according to a medical model with highly structured administration and regulation. As a result, there is tension between the priorities of the resident and the organization. A qualitative study conducted with 4 social workers and 1 physician employed in residential care facilities demonstrates not only the structural barriers to PCC, but also the importance of meaningful relationships to residents' socio-emotional well-being. The final section explores how organizational barriers might be mitigated through the complementary use of relational care.     

Resilience of Young People in Residential Care

Children and young people in residential care may have experienced or may experience various difficult, life-threatening events, such as neglect, abuse, or violence and maltreatment known as adversities. Despite this, some of them are able to function and even prosper and this has been attributed to the development of resilience. In this qualitative empirical study, we focus on the under-researched area of how young people in care reflect on and cope with such adversities. The exploratory research comprised of semi-structured interviews with young people in two different care settings – re-education centres and children’s homes. The results showed that the sample of 34 young people had experienced 73 adversities prior to leaving residential care and that half of them were not able to resolve some of these adversities. It was found that methods for dealing with adversity change during time spent in care and that a combination of various individual strategies, adaptation and accepting support are effective. The findings also indicate that the development of resilience may vary according to type of residential care setting specifically, whether these facilities allow the development of multiple individual strategies for dealing with adversities, or whether they provide social support. The article discusses implications for future research and practice in residential care.     

Unheard voices,unmapped terrain: Care work in long‐term residential care for older people in Canada and Sweden

Daly T, Szebehely M. Unheard voices, unmapped terrain: care work in long‐term residential care for older people in Canada and Sweden This article aims to contribute to comparative welfare state research by analysing the everyday work life of long‐term care facility workers in Canada and Sweden. The study's empirical base was a survey of fixed and open‐ended questions. The article presents results from a subset of respondents (care aides and assistant nurses) working in facilities in three Canadian provinces (n= 557) and across Sweden (n= 292). The workers' experiences were linked to the broader economic and organisational contexts of residential care in the two jurisdictions. We found a high degree of country‐specific differentiation of work organisation: Canada follows a model of highly differentiated task‐oriented work, whereas Sweden represents an integrated relational care work model. Reflecting differences in the vertical division of labour, the Canadian care aides had more demanding working conditions than their Swedish colleagues. The consequences of these models for care workers, for older people and for their families are discussed.     

Use of Space and Human Rights: Planning Dementia Friendly Settings

Environmental psychology has been a topic of great interest for many researchers in the field of aging and dementia. Thus, several orientations can be identified in the contemporary scientific literature concerning environmental design for people with dementia. In this article, we discuss recent research on environmental design models for people with dementia and propose an approach referring to the concept of use of space and human rights.We use a methodology based on observation of special care units to determine an environmental design framework that should be taken into account when designing residential facilities for people with dementia. Content analysis identified 6 primary dimensions and 13 secondary dimensions relevant to the rights of people with dementia. We then discuss the results according to the related literature in environmental psychology and gerontology in terms of well-being and quality of life.     

Research review: Aging out of residential care in South Africa

Approximately 21,000 children were accommodated in residential care in South Africa in 2011/2012. Despite this large number, and the state's substantial financial investment in residential care, there has, until recently, been little research on care‐leaving: the transition out of care due to reaching adulthood. Furthermore, much of the research available has not been published in international journals. This article reports on a systematic review of research on residential care‐leaving in South Africa, from 2003 to 2016. A thematic analysis of the resulting 40 research outputs maps the scope of findings from South African research, in relation to theory of leaving care, measurement tools developed, young people's experiences of leaving care, transitional outcomes, processes of leaving care, facilitators of improved outcomes, care‐leaving services, and policy on leaving care. Critical gaps in the current research opus are identified, with a view to refining future research on young people aging out of care in South Africa.     

CASH,CUSTOMERS, AND CARE: THE EXPERIENCE AND MEANING OF DIFFERENTIAL PAYMENT FOR HIGH CARE PLACES IN AGED CARE FACILITIES

The introduction of new asset/income tested charges for high care residents was the 1997–98 Commonwealth government policy response to concerns about financing residential aged care. This in‐depth study of residents, families, staff and managers in three aged care facilities explores issues of equity, access and empowerment arising when some residents pay more for the same level of care and amenity. The study reports little evidence of financial contributions affecting access to high care places and the delivery of care, the potential for differential access to amenities such as single rooms linked to the extra payments, and no evidence of a sense of empowerment linked to payment of the new charges. The complexity of current financial arrangements, access to appropriate financial advice at the time of entry, and the potential for an informal two tier system in relation to the allocation of amenities are identified as developing policy issues.     

Is home care a realistic alternative to residential care among institutionalized elderly people in Finland?

The high rate of institutionalization among elderly people in Finland is widely discussed among policy-makers. We studied how realistic the wishes for deinstitutionalization are among the least sick elderly people in residential care, and what patient characteristics predict whether residential care is appropriate. This issue was assessed by the residential home personnel. Personnel assessment of institutional care as appropriate was mainly explained by patients' needing help with medication, limitations in activities of daily living, absence of own home to return to, no living children, incontinence, and poor vision. Discharging elderly people from long-term residential care back to society is limited by factors such as inadequate housing and shortage of domiciliary and rehabilitative services, as well as by attitudes among the institutionalized elderly people themselves. It seems more realistic to prevent the inappropriate institutionalization of elderly people than to discharge the small numbers of fairly independent individuals already in residential homes.     

Caring for Troubled Children in Flanders, The Netherlands, and the United Kingdom

Correspondence to Dr Matthew Colton, Lecturer in Applied Social Studies, Centre for Applied Social Studies, University College of Swansea, Singleton Park, Swansea SA2 8PP. Summary This article reviews research on residential care and otherservices for troubled children in Flanders, the Netherlands,and the United Kingdom. We begin by looking at Flanders andthe Netherlands. This includes an account of the organizationof services and a critical evaluation of initiatives resultingfrom the growing dissatisfaction with residential care overrecent years. We then compare the evidence from these two countrieswith the situation in the United Kingdom. Notwithstanding importantdifferences, there are clear similarities in the issues surroundingthe residential care of children in the three countries. Weconclude by outlining likely future developments in residentialchild care.     

Treatment progress of foster care adolescents with severe behavioural problems: Factors conditioning their performance in the residential treatment centres

Behavioural problems are a recurring issue in the child welfare system population. Normative residential centres do not have the characteristics to address the specific needs of these adolescents, so they are usually treated at therapeutic residential centres. In Catalonia (Spain), these cases are treated in intensive educational residential centres (CREIs), a variant of therapeutic residential care (TRC) facilities. This exploratory study seeks to understand the treatment progress of adolescents with severe behavioural problems who were placed in the CREIs, a variant of TRC facilities. Data from 206 cases, the totality of population under treatment in the CREIs, were collected using a questionnaire administered to the treating team. A cross‐sectional design was used, applying quantitative methods to analyse the incidence and interrelation of a series of variables related to the progress of adolescents in the CREIs. Significant differences among profiles by sex, place of origin, criminal offences, substance abuse and mental health disorders were found. Furthermore, adolescents who performed a positive treatment progress according to the professional staff arrived at the CREI at an earlier age and had longer stays than the group with an unremarkable progress. Logistic regression indicated that duration of stay in the centre and runaways predict the adolescents' treatment progress. This treatment is working well with the milder cases; however, it does not tend to be successful for adolescents with greater difficulties. It is recommended that interventions focus on factors that engage the adolescents in their own rehabilitation process, include substance abuse programmes and consider the gender perspective.     

A good death for residents of long-term care: family members speak

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/ assisted living facilities. Structural components of care including staffing adequacy, training, and consistency as well as facility environment and size were important factors for family members interviewed. "Being there" and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

Depression and caregiver burden among rural elder caregivers

Family caregivers of older adults frequently experience feelings of burden and depression though they may not come to the attention to health and service providers until they are at a point of crisis. Through a simple screening tool, the Maine Primary Partners in Caring (MPPC) project identified individuals providing care to older adults through rural primary care practices, in order to provide upstream interventions before caregivers were in crisis. This paper describes a sample (n=62) of rural family caregivers identified through their physicians' offices. High levels of caregiver burden and depression were reported. Family support and knowledge of caregiver tasks predicted decreased caregiver burden and depression, while isolation predicted increased caregiver burden. Implications of these results for gerontological social workers are outlined.     

Residential Treatment: Contextual Learning and Demand for Work from a Social Group Work Perspective

ABSTRACT

This paper examines the implications of integrating social group work theory to residential treatment facilities in order to improve therapeutic engagement of clientele. This examination focuses on the natural and serendipitous construction of groups within residential treatment facilities. These natural groups provide frontline workers with constellations that are symmetrical to the knowledge-base of social group work theory. In addition, this paper incorporates the initial phases of social group work stage theory as a means of providing opportunity for contextual learning to residential clientele as well as planning appropriate demand for work within these settings.     

Changing Places: Men Replace Women in Mental Health Beds in Britain

Based on census materials collected in England and Wales from 1921 to 1991, this study focuses on gender differences in occupancy rates in hospitals and other mental health facilities in Britain. The results suggest that since 1991, or for the first time in the twentieth century, there are more males than females in residential mental health facilities in Britain. Furthermore, this pattern of association holds for all age groups except those aged 65 years and over. Second, there are currently two distinct subpopulations in mental health facilities—a male group which is predominantly of working age, and a female group, which is predominantly of retirement age. The existence of these two "care" populations will impact significantly on current and future resourcing of mental health services. The policy implications of the research findings are discussed within the context of the debates on the changing relationship between gender and mental health.     

A Good Death for Residents of Long-Term Care

Abstract

Little research has been done on the topic of end-of-life care in long-term care settings to identify important themes regarding end-of-life care structures, processes, and outcomes. This study utilized data gathered in a stratified, random sample of 437 family members of residents who died in 31 nursing homes (NHs) and 199 residential care/assisted living facilities. Structural components of care including staffing adequacy, training, and consistence as well as facility environment and size were important factors for family members interviewed. “Being there” and manner of care delivery (e.g., staff attitudes/empathy) were major elements in the process of care. These factors were mentioned more than direct care, Hospice, or resident preferences. Family members identified themes of [dying at] home and being comfortable and clean as important outcomes of care. These identified structural components, processes, and outcomes have implications for the role of social workers in these settings despite that social work support is notably absent in these findings.     

在公平与效率之间:对北京市养老资源的空间分析

基于网络采集的养老机构数据和第六次全国人口普查数据，以公共设施区位理论为框架，使用空间分析方法，本文对北京市养老资源的分布模式进行了研究。研究发现，在乡镇/街道层面，整体上公办养老资源分布相对均衡，呈现正的空间依赖，民办养老资源则局部呈现负的空间相关性特征。空间回归分析表明，尽管两者布局均受到辖域内服务对象绝对数量这一因素的影响，但民办养老资源分布对老年人口密度这一指标更为敏感。不同类型的养老资源分散与集聚的空间模式，体现了公共设施供给问题上效率与公平原则之间的对比关系，这是行政与市场力量形塑的结果。     

Cognitive-behavioural interventions for adolescents in residential child care in Scotland: an examination of practice and lessons from research

This paper sets out to examine the basis and use of cognitive‐behavioural interventions with adolescents in residential child care. The paper outlines the results of a survey of the use of cognitive‐behavioural interventions in Scotland. The survey indicates that such interventions are used widely in residential schools and secure units in Scotland. The paper then reviews some of the studies relating to cognitive‐behavioural interventions, which appear to be most relevant to residential child care. The review revealed many of the positive outcomes of cognitive‐behavioural interventions. However, there are some cautionary notes highlighted by the survey and the review. These relate to issues about generalization of learning and the meaning of the intervention for the young person and for the staff. The paper discusses the importance of other factors in determining the success of cognitive‐behavioural interventions. These factors include the importance of accurate assessment, the role of staff training and the need to ensure that interventions are always in the best interests of the child.