Choosing Privacy over Interaction: Restructuring Expectations and Interpretations of Community Integration in Canadian Small-House Long-Term Care Settings

In Nova Scotia, Canada, the small-house model of care has been introduced as an alternative to institutional care settings, and the province has funded and built 11 new long-term care (LTC) communities in the small-house model. Each of the new facilities was built with multiple cottages housing 12 to 15 residents; each cottage features private bedrooms and a residentially scaled kitchen and dining area. Through smaller numbers of residents living in home areas, the goal of the Provincial Department of Health was to encourage relationship building, as well as to provide opportunities for autonomy and choice in resident daily living. A qualitative case study was conducted in one of these small-house communities, focusing on the model's impact on resident interaction and community integration. Thematic analysis revealed that while resident social patterns were directly impacted by the physical environment and culture of care in the new model, interpretations of these patterns by staff and family members were influenced by preexisting expectations of community integration rooted in institutional care models of the past.     

The Role of Environmental Features in Social Engagement Among Residents Living in Assisted Living Facilities

The objective of this study was to describe how physical and social environmental features of assisted living facilities influence social engagement behaviors of older residents. A secondary objective was to identify the environmental features that were important to residents’ social engagement based on their perspectives. Using a qualitative approach, the authors depicted the environmental features and the social engagement patterns of older residents in two assisted living facilities in urban Saint Louis, Missouri. A stratified sample of 10 participants participated in in-depth interviews and 16 participant observations were conducted. Five physical and social features were identified as factors that influenced residents’ social engagement patterns. Environmental features that supported social engagement appeared to differ according to participant activity level. Findings from this study have the potential to inform design guidelines that will enhance social engagement in future assisted living facilities.     

Fair play: creating a better learning climate for social work students in social care settings

This paper describes a pilot study and subsequent evaluation undertaken by the author which arose from his experiences as a practice teacher working with a student in a day care facility. The catalyst for the study arose from one student's comments about the confusion he and others on the placement site experienced regarding his role as a social work student in a setting where there was no defined social work role.

It led to a study of students' views in a range of settings across South & East Belfast Trust, some of which may be deemed to be ‘social work settings’, i.e. with a defined social work role, while others may be considered ‘social care settings’, i.e. with no defined social work role. The aim of the study and subsequent evaluation was to consider problematic issues which arose for students in social care settings and how the quality of learning opportunities for them could be improved.     

Conflicts,friendship cliques and territorial displays in senior center environments

Humans are territorial, laying claim to places and objects as a way of regulating social interaction and fulfilling a variety of social motives. We observed territoriality to facilitate both inclusionary and exclusionary group behaviors within senior center spaces. We observed approximately 300 participants over 120 h and interviewed 30 participants in three multipurpose senior centers. Territories supported group identity and interaction for friends who shared dining tables in two centers. However, those two centers also had frequent dining area territorial conflicts and few other spaces or opportunities for meaningful center participation. The conflicts entailed the reinforcement of social cliques at the cost of exclusion of others. A third center exhibited fewer territorial conflicts and a wider variety of shared and attractive settings, such as a living room and hobby rooms. In addition, strong self-governance of this center allowed participants to lay claim to the entire center, rather than relying on ownership of specific dining seats.     

Mom and Pop Versus the Big Boys: Adult Family Homes as Providers of Medicaid-Funded Residential Care

This paper compares assisted living apartments (ALs), adult residential care facilities (ARCs), and small adult family homes (AFHs) for Medicaid residents in Washington State, with particular emphasis on the settings, staffing, services, and policies of AFHs. We targeted for enrollment all residents entering an AFH, ARC, or AL setting on Medicaid/state funding in a three-county area of Washington State. We obtained information on 199 settings, interviewing administrative and direct care providers. AFHs are smaller than ARCs and ALs and less likely to be part of a chain, with no significant difference in staffing ratios of registered nurses and licensed practical nurses. Sixty-four percent of AFH residents were receiving public funds compared to 32% of AL residents. AFHs report admitting residents with more activities of daily living needs, health conditions, and behavior problems. They are less likely to have autonomy-related policies, and they provide more services and fewer activities. While attention should continue to be paid to staff supports, policy and practice should support the continued role of AFHs, which are of special interest because of their potential to provide more homelike, less costly care but with possible trade-offs compared to larger facilities.     

Advancing social inclusion in the neighbourhood for people with an intellectual disability: an exploration of the literature

The shift from segregated facilities to community settings did not automatically lead to social inclusion for people with an intellectual disability (ID). Policies are increasingly decentralized but little is known about the factors that are important to realize social inclusion in the neighbourhood. This literature study identifies five domains barriers and facilitators for social inclusion in the neighbourhood: individual characteristics, informal network, professional care, neighbourhood characteristics, and government policies. The findings suggest that social inclusion in the neighbourhood is a dynamic process that shows a series of complex interactions between environmental factors and personal characteristics to provide opportunities for people with an ID. It is recommended to include the perspectives of people with an ID and other neighbourhood residents in future research on social inclusion. Specific attention is needed for the role of neighbourhood social capital in achieving social inclusion in the neighbourhood.     

Social Interaction in a Heterogeneous Apartment: An Investigation of the Effects of Environment upon Behavior

Abstract

This paper examines the relationship of propinquity (spatial proximity) to social interaction in a heterogeneous apartment, specifically, whether spatial propinquity or social homogeneity is the better explanation for resident interaction. We also examine the effects of other characteristics of the apartment design upon interaction patterns among apartment residents. Data are derived from in-depth structured personal interviews with residents of the apartment complex and are analyzed with standard sociometric techniques. Findings indicate that while propinquity and other design features may precipitate initial contact and interaction, this contact will remain superficial unless it is reinforced by shared social and demographic characteristics. The implications of these findings are discussed in light of the literature about the effects of the man-made environment upon behavior.     

Social work in the development of institutional care for older people in Slovenia

Social work in homes for older people in Slovenia has a special role since we have extremely institutionally-oriented care for older people. Characteristic of the development of Slovenian homes for older people is a shift in the dynamics of the orientation of the homes from a medical to a social one. Different factors influenced the shift towards a social orientation, i.e. the policy of establishing homes, the influence of sociogerontological principles, the development of social work and, recently, by their engagement with residents with dementia. In socially-oriented homes a different model of social work is used than in medically-oriented ones. The difference lies in social work methods as well as in the roles of the social worker in different areas of work with the residents, relatives and staff. By defining a model of social work in a socially-oriented home, a special field of social work with older people in the field of institutional care in Slovenia has been developed.     

Culture Change in Aged-Care Facilities: A Café's Contribution to Transforming the Physical and Social Environment

Objective: To discuss the potential of a café on the premises of an aged-care facility as a vehicle for culture change. Method: Secondary analysis of primary qualitative data that explored the value of a café in an aged-care facility, compared with culture-change principles established from a literature review. Results: Secondary analysis established congruence between culture-change principles and the themes established in the primary qualitative data. A café, in one aged-care facility, has facilitated the following dimensions of culture change for residents: individualized care, facilitation of meaningful relationships, opportunities for participation in life roles, and creation of a sense of belonging. Conclusion: Culture change can be achieved through environmental innovations, such as a café, where food and dining maximize social opportunities and create a homelike environment that facilitates continuation of residents' identity.     

Social Constructions of Young Children in ‘Special’, ‘Inclusive’ and Home Environments

The paper tells of the social constructs surrounding young children with learning difficulties in their home, ‘special’ early education setting and ‘inclusive’ or mainstream early education setting in England. The exploratory study focused on how three‐ to four‐year‐old children made sense of their environments and how their identities were constructed by different parties in the different contexts. Ethnographic case studies were conducted using semi‐structured and informal interviews with parents and practitioners, documentary analysis, fieldnotes, and live and video observations. Shared constructions across the contexts for each child were common, with constructions of them being happy and making progress pervasive across the children and settings. Differences in constructions across settings indicated that qualities could shine or negative constructions be tempered, thus showing the role of the environment and the culture of inclusion in socially constructing children with special needs.     

An Innovative Behavioral Health Workforce Initiative: Keeping Pace with an Emerging Model of Care

ABSTRACT

Recent policy shifts in health care have created opportunities for social workers to provide services in integrated primary care and behavioral health settings. However, traditionally prepared social workers may not have the skill set necessary to meet practice demands. This article describes a behavioral health workforce initiative that trains master’s of social work students for work in integrated primary care settings with children, adolescents, and transition-age youths. The training model includes field placements in integrated care settings, co-curricular seminars, and advanced clinical electives. This article identifies challenges of creating new field placements and developing new curricula to support students’ acquisition of knowledge and skills required in integrated care settings. Additionally, it presents data on changes in students’ knowledge and confidence.     

Laughter for sale

An audio-visual recording is examined in detail to show how humour can be made available as an economic good and, at the same time, employed as a means of social control. It is argued that, in unstructured settings, vendors face special interactional problems in accomplishing economic exchange and that the special features of humour as a form of discourse and social action can be used to deal with these problems.     

Communities within communities: Changing ‘residential’ areas at Cultus Lake,British Columbia

Research focusing upon rural Canada continues to highlight the complex outcomes arising from rural-urban interactions within particular geographic settings. In the ‘city's countryside’, amenity landscapes located near the urban fringe are developed as the domain of vacation- and recreation-seeking urban residents. Yet, these recreation amenity sites are also set within an existing rural landscape. The land uses and social patterns found within this setting represent an outcome of the interactions between these competing landscapes. This paper examines residential change within the rural-recreational areas around Cultus Lake, British Columbia. Comparison of the local population to those living permanently within the cottaging areas is made across selected socio-economic characteristics and household activity patterns. These comparisons are extended to the group level by examining social and spatial constructions of local community ‘institutions’. Together, these comparisons suggest a ‘shared but separate’ geographic space.     

A study of the utility of the child behavior checklist with residentially placed children

An evaluation study was conducted to determine the potential usefulness of the Child Behavior Checklist (CBCL) with children placed in residential settings. The CBCL, the Global Assessment Scale, the Progress Evaluation Scales, and the Jesness Behavior Checklist were completed for 97 children in community residential treatment. Children categorized by the CBCL as Externalizers were found to be more obtrusive, hostile, alienated, nonconforming, attention seeking, and sensitive, and less responsible, insightful, and considerate than were Internalizers. The total problem score, the Internalizing scale score, and the Externalizing scale score on the CBCL were significantly correlated with problem severity, predicted length of stay, and a measure of placement appropriateness. These three total scores proved to be useful measures of residentially placed children. Results suggest that a high score on the Externalizing scale may reflect the presence of behaviors difficult to deal with in a residential environment. A high score on the Internalizing scale may be no less serious, but involves behaviors less disruptive of the group setting. The potential value of the CBCL for evaluating residentially placed children is discussed.     

Covenants of care: The symbols of community support for elders in the all-black towns of Oklahoma

This article explores community covenants of care that benefit older residents in the all-black towns of Oklahoma. Community covenants of care are informal agreements by community residents that favor support of people residing in the community. The covenants are expressions of the social histories of the towns themselves and are intertwined with other social–historical themes, including positive racial identity and racial self-determination, expectations of limited external support, community self-reliance, and special status afforded to elders. There are numerous expressions of community covenants of care within the all-black towns. Although the manifestations of positive community covenants may require considerable time and effort to identify in poor rural minority communities, such as the all-black towns, the experience can lead to a deeper and more comprehensive understanding of the lived experiences of older residents and their community roles.     

Caring for day care: a pilot project

Day care in Israel is not always of high quality, and the current forecast for upgrading the standards of the existing centers is bleak, due to economic and social factors that do not place high priority on quality infant care in group settings. The agency attempted, therefore, to develop a low-cost, efficient method of early intervention, wherein skilled social workers were hired, given special training, and worked alongside the caregivers of day care centers to help children and parents defined as at risk. This article describes the observations that were made and the interventions that were chosen.     

Determinants of residential group development and social control

The present research is concerned with the effects of architecturally determined residential group size on the development of social groups and norms of social control over shared interior spaces. Previous research has revealed a positive relationship between residential group size and the importance of residential group formation as a moderator variable in the numerosity crowding-relationship. It was predicted that residents of a long-corridor dormitory (36–40 per floor) would be less likely to form social groups and convert shared public spaces to group-controlled semiprivate interaction loci than residents of a short-corridor dormitory (60–63 per floor subdivided into clusters of approximately 20 by design features). A series of interview, observational, and field experimental studies yielded data supporting this hypothesis. Long-corridor residents expressed lower feelings of control over what happened to them in shared interior spaces and reported that they exerted less group-derived social control over hallway space than did short-corridor residents. In contrast to long-corridor residents, subjects residing in the short-corridor design were more likely to report that other areas of their floor were under the proprietary interests of neighbors and their patterns of space use reflected this perception. Long-corridor residents were also found to be less socially responsive to another person's presence in shared areas over which they exercised less social control than did short-corridor residents. The results are discussed in terms of the inhibiting effect of large group size on the development of residential social control and the ability of residents to regulate local social contact.     

Youths in coercive residential care: attitudes towards key staff members’ personal involvement,from a therapeutic alliance perspective

A strong therapeutic alliance between staff and juveniles (residents) in institutional settings is considered to be important for a positive treatment outcome. The article focuses on residents placed in coercive care in Swedish residential treatment centres (RTCs), and the aim is to explore obstacles and opportunities for establishing a therapeutic alliance between key staff members (KSMs) and residents in a one-year perspective. The key question is how residents view their KSMs’ personal involvement and active participation in their treatment process. Semi-structured interviews were conducted with twenty-thre girls and twenty-three boys placed in ten different RTCs, and follow-up interviews were conducted after one year. In accordance with the theoretical approach, it is hypothesized that the residents’ view of KSM involvement will be more positive in the one-year follow-up. Results from the first data collection show that more than half of the adolescents perceived their KSMs’ personal involvement as mainly negative. Between the two interviews, several had developed a more positive view of the KSMs’ personal involvement, while a large group did not display any change in attitude. Positive and negative institutional conditions and processes affecting the prospects for the development of a therapeutic alliance between residents and KSMs are discussed.     

Nearby Nature and Long-Term Care Facility Residents

Abstract

As the population in North America continues to age, long-term care facilities for housing the elderly are likely to become even more important. Because one of the primary foci of these facilities is on sustaining and enhancing quality of life while eventually helping patients and families cope with the dying process, both the physical and social environments are critical to the facilities' success and the users' well-being. Healing, or restorative gardens and other designed green spaces have been suggested by many academics and practitioners as important components of these environments, yet there has been relatively little systematic research on the use and benefits of nature in this context. Do elderly residents of long-term care facilities benefit from access to outdoor areas? What are the design characteristics that are most important for this unique population?

Forty elderly residents of three different urban long-term care facilities were interviewed about the importance of outdoor green spaces and views within the facility, their use of the facility's outdoor spaces, benefits they derive from those spaces, and barriers to using the spaces. Facilities differed both in terms of the amount of nature in their outdoor spaces and in the design of, scale of, and access to those spaces. Results show that overall residents place a high value on access to green spaces and derive a number of benefits from these spaces, yet they spend relatively little time in these settings. Barriers to greater use of outdoor spaces included physical limitations, lack of staff assistance, and design issues. Implications for the value of nature spaces in long-term care facilities are discussed, along with specific design recommendations.     

Contemporary Social Work Practice with Veterans: An Introduction to the Special Issue

This special issue is a historical marker for contemporary social work practice with veteran populations. The editors requested papers from private, public, and academic settings that illustrate the special needs of veterans. The articles in this issue address the impact of military culture and the veteran identity, diversity, eras of service, access to care, and different stages psycho-social development on clinical practice. This introduction places the articles submitted in the context of historical and current trends in veterans’ research concluding with a call to recognize resilience inherent in this population. It is hoped that this issue will serve as a tool for clinicians, researchers, and educators to improve upon their work as well as bring a new generation to serve and support those who served.