The Effects of South Korean Social Workers' Professional Resources on their Understanding of a Patient's Right to End‐of‐Life Care Decisions in Long‐term Care Facilities

The aims of this study were to examine South Korean social workers' understanding of a patient's right to end‐of‐life care decisions (EOLCD) in long‐term care facilities and to explore the effectiveness of their professional resources in their understanding of this issue. A survey was conducted of 297 social workers from multiple long‐term care facilities in South Korea using structured questionnaires and face‐to‐face interviews. A multiple regression model was used, controlling for gender and religion. The participants' professional resources were measured by years of work, license type, number of beds, knowledge of advanced directives, experience in the EOLCD process, and training. The results demonstrated that South Korean social workers' understanding of a patient's right to EOLCD was moderate (mean 3.46), and their general (β = 0.576, P < 0.001) and medical knowledge (β = 0.117, P < 0.001) of advance directives, experience in the EOLCD process (β = 0.222, P < 0.001), and training (β = 0.028, P < 0.001) positively and significantly increased their understanding of patient rights (R² = 0.449, P < 0.001). The findings suggested that the development of academically supported and legally enforced standards and regulations for an EOLCD practice manual for long‐term‐care social workers would be beneficial.     

Into adulthood: a follow-up study of 718 young people who were placed in out-of-home care during their teens

In this study, national register data were used to analyse long‐term outcomes at age 25 for around 700 Swedish young people placed in out‐of‐home care during their teens. The sample consisted of 70% of all 13‐ to 16‐year olds who entered out‐of‐home care in 1991. Results revealed a dividing line between young people placed in care for behavioural problems and those placed for other reasons. Young woman and men from the first group had – in comparison with peers who did not enter care – very high rates of premature death, serious involvement in crime, hospitalizations for mental‐health problems, teenage parenthood, self‐support problems and low educational attainment. Young people who were placed for other reasons had better outcomes, but still considerably worse than non‐care peers. Young women tended to do better than young men, regardless of reasons for placement. Very high rates of hospitalizations for mental health problems were found among young people placed for behavioural problems. Breakdown of placement was found to be a robust indicator of poor long‐term prognosis.     

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.     

“The Persistence of Parent Repayment” and the Anticipation of Filial Obligations of Care in Two Thai Provinces

With an accelerated and sustained decline in fertility and an increase in life expectancy, Thailand has entered its aging phase at a rapid pace. This raises an important question of who should care for the increasing elderly population. Using a survey of adults aged 16–64 years (n = 742) in two provinces in the north‐east (Kalasin) and south (Phang Nga) of Thailand, this paper explores the expectations that individuals have from their children when they become very old. Only one‐third of the respondents expected to live with their children in old age and only one‐fifth anticipated financial assistance. Less than half of them expected personal care and practical care from their children (43% and 38%, respectively). The expectations varied substantially by the number of children and income, with those with higher income reporting lower expectation. Those living in Kalasin, a much poorer province than Phang Nga, had greater expectations from their children in old age. This suggests that, for those with less financial resources, children remain the main care provider for the elderly.     

Experiences of Young Indian Girls Transiting out of Residential Care Homes

Leaving the residential care home is one of the most significant occurrence in the life of every care‐leaver. It encompasses vast changes which has a long term impact on the care‐leavers future. This study captures the lived experiences of twenty‐four young Indian girls who have left care in the past four years. It addresses their journey of moving out of care at two levels — their preparation to leave care and their present experience. The primary focus of the study is to explore the interpretation and meanings attributed by these girls to the phenomena of transition out of care; identifying the uniqueness and commonalities that emerges from their experiences. The results exposes a plethora of emotions and episodes the girls have encountered at each step of their path. It also emphasises on the role played by multiple environmental factors — support network (friends, peer group, family, social workers, etc.), residential care home, state and other social processes — operating at different systemic levels, highlighting the interface between the ‘self’ and the ‘environment’, based on the Ecological Framework.     

Citizens' views in four jurisdictions on placement policies for maltreated children

Citizens' opinions on child protection public policy are a key dimension of the legitimacy of a political order. We have conducted a survey vignette on a representative sample of citizens (N = 4,003) in England, Finland, Norway, and California, USA. The findings show that citizens' opinions are clearly in favour of adoption (75%) rather than long‐term foster care (25%). Context may partly explain the findings, as the responses of the majority of Anglo‐American respondents are in line with practice in their countries but for the Nordic respondents, there is a substantial discrepancy between citizens' opinions and on‐going child protection practices.     

Exploring drivers of demand for child protection services in an English local authority

This paper reports on an empirical study of child protection services in a local authority where rates of investigations and interventions rose to unprecedented levels during the course of a single year. The aim of the research was to explore explanations for this rise in demand among the providers of children's social care in the area. Using an interpretative qualitative design, a series of focus groups and interviews were carried out with practitioners and managers (n = 25) from statutory services and Early Help. The findings identified a combination of long‐term and short‐term drivers of demand. Long‐term factors emphasized the impact of rising levels of deprivation combined with cuts to community‐based services for children and young people. Short‐term factors ranged from a more proactive approach to child neglect to more effective multi‐agency partnerships and joint decision making. The interaction between these factors was found to be accentuating an underlying shift to “late intervention” across the sector. The findings are contextualized in relation to contemporary debates about the crisis of demand for children's social care and the complex relationship between prevention and protection.     

The vicious layering of multilevel governance in Southern Europe: The case of elderly care in Italy and Spain

Aging and changes in family arrangements and female employment have brought about important policy developments in long‐term care (LTC). Southern European countries have relied for a long time on family care and residual social care for the dependent elderly. Two paradigmatic cases, Italy and Spain, have shown two apparently different trends during the last 15 years: while in Italy, reforms seem to have been persistently blocked, in Spain, an ambitious reform has fallen short of expectations. Based on data on services and institutional arrangements, the article shows that a complex and inconsistent allocation of responsibilities across government levels, a sort of “vicious layering” of multilevel governance, may be playing a key role in this situation. The article discusses the dysfunctional effects of such arrangements, namely territorial inequalities, cost‐shifting between government levels and towards users, and misallocation of resources. We suggest that the development and reform of LTC in Southern European countries must address these problems if they want to avoid getting marooned by a complex network of vetoes and resource allocation problems.     

Child Well‐Being Scales (CWBS) in the assessment of families and children in home‐care intervention: an empirical study

This paper reports research carried out in Italy designed to investigate the usability of Child Well‐Being Scale (CWBS) for the outcome evaluation of home‐care interventions for vulnerable families and children in need. Using a pre‐ and post‐test design, the study traces the changes in 18 vulnerable families and 23 children in need included in a programme of home‐care intervention over a period of 11 months. All the families and children were assessed twice: at intake and at the end of the intervention (after 6 months). Furthermore, 10 families and 11 children had a longer intervention and were assessed three times. Moreover, two focus groups involving 13 home‐care workers and 11 face‐to‐face interviews were used to collect practitioners' points of views on CWBS. The results generally support the idea that families' and children's situation improved over time, as shown by an improvement in almost all of the considered dimensions after 6 months and after 11 months. Specifically, the families improved more on household adequacy in the long term while children on the child performance dimension improved in the short term. Practitioners reported that CWBS was an aid to multi‐professional decision‐making, as the systematic evaluation of the subscales was a practical base upon which to activate shared decision‐making during the casework.     

Needs and availability of support among care‐leavers: A mixed‐methods study

Data are scarce on the long‐term needs of care‐leavers and on the support resources that are available for them in the years after leaving care. This mixed‐methods study presents data on the needs and availability of support of 222 Israeli care‐leavers, suggesting that the most urgent needs of care‐leavers are a lasting need for a stable and available support figure and assistance with educational issues. For some care‐leavers, these needs are fulfilled by their mentors. Parents and other familial figures were found to be the most common support resource for care‐leavers, which highlights the need for the intervention of social workers to improve relationships within families while the children are still in care. Due to high rate of young people who have no support resources and a low rate of services utilization, social services should provide a platform to support this group, using mentors and other supporters. The longitudinal data of up to 4 years after leaving care indicated that the availability of various types of informal support improved over the years, and the reports on difficulties in relationships of the care‐leavers with their parents were significantly fewer 4 years after leaving care than on the verge of leaving care.     

Change and Adaptation in Families with Young Carers

Using grounded theory methodology, members of nine families with 'young carers' were interviewed to explore their experiences of caring. A dynamic theory of change and adaptation emerged in relation to changes in who cares within families, in external support and in the attitudes of young carers towards caring. Adaptations included becoming used to the way life is, knowing how to care, balancing and trading off, rewarding care, and anticipating future adaptations. A model has been developed to offer an explanation of factors which influence young caring in families. These include family expectations about caring; who is available to care; the willingness and capability of young carers to help; and the degree of choice or obligation they experience. Formal and informal support services from outside the family, and environmental adaptations, can reduce the amount of family caregiving required, increase choice and contribute to balancing life for carers.     

Readiness for independent living of youth in residential childcare: A comparative study

Transition to adulthood is an accelerated and early process for care leavers that requires intensive preparation, training and support from child welfare services. This study aimed to explore the perceived readiness for independent living of a group of care-experienced young people preparing for leaving care in Spain and to compare it with the perceptions of their peers from the general population. A sample of 508 youth (50% women) aged 14–21 (M = 16.67; SD = 1.72) took part, of whom 279 were care experienced and 229 belonged to the general population in Spain. Participants' independent living skills, personal autonomy, self-efficacy and sociodemographic characteristics were assessed through an online survey using standardized instruments. Care-experienced young people displayed higher levels of life skills and autonomy in self-care, daily living at home and employment domains, but not related to making daily arrangements in their community. However, their educational level and self-efficacy levels were lower than in the comparison group. Work experience stood out as a significant predictor of care-experienced young people's life skills level. These findings support the importance of assessing life skills as an outcome of leaving care preparation services and providing care-experienced young people with real-life experiences to develop their life skills.     

Foster children as young adults: many motherless, fatherless or orphaned: a Swedish national cohort study

We examined prevalence of parental deaths among former out‐of‐home care youths at age 18 and 25, and odds of parental loss compared with peers from similar socio‐economic childhood backgrounds. The study utilized Swedish national register data for 12 entire birth cohorts (1972–1983), 35 550 former out‐of‐home care youths and 1 138 726 cohort peers without out‐of‐home care experiences. Logistic regression models were used to compute odds ratios for parental loss through death. It was especially common among former residents of long‐term out‐of‐home care to be motherless (11%), fatherless (11–13%) or orphaned (3–4%) at age 18, compared with non‐foster care peers (1%, 3% and 0.03%). Twenty‐six per cent had lost at least one parent (4% among non‐foster care peers). At age 25, the figures had increased considerably; 36% had lost at least one parent, compared with 7% in the majority population. Adjusted odds ratios for parental loss among long‐term care youth were strikingly high, particularly for having a deceased mother. In short‐term and intermediate care, most youths with deceased parents had suffered parental loss before entering foster care. For youth from long‐term care, parental death after start of placement was most common.     

The Effect of Financial Incentives and Access to Services on Self-funded Admissions to Long-term Care

With the growth in the numbers and proportion of older people in the population the funding and incentive structures around long‐term care are of international concern. A study of the circumstances of self‐funded admissions to care homes allowed the comparison of self‐funders with publicly funded admissions to care homes in the UK, the influences on self‐funders in their decision to move into a care home and resources on which they were able to draw. These findings contribute to our understanding of the impact of current policy on self‐funders and our thinking about the way that future policy and practice changes could improve the way we use society's resources in the provision of long‐term care.     

Stability and change – a 7‐ to 8‐year follow‐up study of mental health problems in Norwegian children in long‐term out‐of‐home care

The aim of the study was to explore stability and change in mental health problems in Norwegian children aged 6–12 years old (n = 70) in long‐term out‐of‐home care. The children's mental health problems were assessed shortly after the placement and 7–8 years later by the caregivers and the teachers on the Revised Rutter Scales. Information on pre‐placement and placement factors were collected from the child welfare workers. At a group level the children's mental health problems had improved significantly over time according to the teachers' reports. According to the caregivers' reports, however, the children's problems were high and stable across time. Analyses aimed at detecting individual changes revealed a great variability in development according to both informants, indicating that treating the placed children as a homogenous group could be misleading. Several pre‐placement and placement variables were associated with the change in the children's mental health problems from the time of placement to the follow‐up time according to both informants' reports. However, all the predictors were accounted for by the strong effect of the children's problem scores when entering care.     

Economic self-sufficiency and the employment outcomes of care leavers: A 10-year follow up

Gaining employment and reaching a stable and self-sufficient livelihood are essential life tasks, especially for young people ageing out of public care. This longitudinal study followed alumni of welfare and educational residential care settings in Israel for 10 years after leaving care. Here, we describe care leavers' employment and economic self-sufficiency outcomes and examine differences over time in their experiences. They were interviewed at the age of 19, 1-year post-care (N = 235), 3 years later (N = 222) and 10 years after ageing out (N = 151). Results paint a mixed picture. While the majority of participants were employed, many in stable jobs, their wages were low even as they grow older. At the same time, they experienced significant economic hardships. For some, economic hardship decreased with time, but for others it remained a cause for concern. Our findings highlight the inherent dependency between experiences at different life stages and suggest that providing more support to care leavers would improve their economic outcomes.     

Future expectations of young people leaving youth care in Flanders: the role of personal and social capital in coping with expected challenges

What do young people leaving youth care think about their future? How do they view their transition between youth care and adulthood? These questions were answered by 71 young people leaving youth care in Flanders. The analysis of the interviews showed that three groups of young people can be distinguished when it comes to their expectations regarding the transition: those with positive future expectations that do not expect any difficulties during their transition, those with positive future expectations expecting difficulties that will eventually pass, and those with negative future expectations, who do not expect their transition difficulties will pass. Most respondents think the future is looking bright, because they are about to graduate or have graduated, and/or because they are intrinsically motivated to deal with their anticipated transition difficulties. Young people with negative future expectations do not stress their intrinsic motivation. Some of them think a (future) partner and their parents will be able to support them through their difficulties; they do not consider professional support as helpful, however.     

Use of population measures and norms to identify resilient outcomes in young people in care: an exploratory study

The purposes of this study were to derive a new method for identifying resilience (i.e. positive adaptation in spite of serious adversity) among young people in care and to determine the percentage of the latter who experienced resilience on selected outcomes, as conceptualized from within the developmental approach of Looking After Children. The participants comprised two samples of young people who were living in out‐of‐home care (mainly foster care) in the province of Ontario, Canada, 340 aged 10–15 years and 132 aged 5–9 years. Virtually all had experienced severe adversity in their families of origin, such that in most cases the legal custody, care, and control of the young people had been permanently transferred from their parents to a local Children's Aid Society. Corresponding to each in‐care sample was a general‐population sample of the same age range that served as a normative comparison group and was drawn from the National Longitudinal Survey of Children and Youth (NLSCY). The NLSCY is an ongoing, long‐term social‐policy study of the development of a nationally representative sample of Canadian children into adolescence and early adulthood. The general‐population samples were composed, respectively, of 5539 young people aged 10–15 years and 11 858 children aged 5–9 years. Resilience among the young people in care was operationally defined, on each outcome variable, as average or above‐average functioning relative to that of the general‐population sample of the same age range. The percentage experiencing resilience was relatively high on the outcomes of health, self‐esteem, and pro‐social behaviour, moderate on the outcomes of relationship with friends and anxiety and emotional distress, and low on the outcome of academic performance. The implications of the findings are discussed.     

Making a connection: school engagement of young people in care

Intervention to improve educational attainment for children in out‐of‐home care is increasingly being recognized as important for their well‐being and future opportunities. This paper reports on a mixed method study of the school engagement or connectedness of young people in care. The study comprised a survey of 202 young people in care in Queensland, Australia, and a matched comparison group of young people not in care, plus interviews with a subset of 65 young people in care who were surveyed. Both the school environment and the perceived levels of support influenced school engagement, with those who were assisted by carers and caseworkers more likely to be positively connected with school. These young people perceived education as a pathway to achieving work and life goals. The findings suggest that active and focused attention on young people's school engagement should be part of case planning and monitoring as it offers an additional strategy for improving their educational experience.     

The social networks of young people in Ireland with experience of long‐term foster care: some lessons for policy and practice

This paper presents findings from the first study of the social networks of a group of young people in Ireland who have experienced long‐term foster care. The study group was composed of two groups of young people, a group who were currently in care and a group who had left the care system. The central focus was to examine the impact of foster care on the social network experience of the young people. Findings indicated that foster care impacts on the young people's social network experience in the following ways: losing contact with extended family; a greater challenge in making and sustaining friendships; an impact on education; and an inability to maintain contact with groups and activities that are of significance. This paper also presents recommendations in relation to policy and practice, including the raising of awareness of the importance of a social network approach in working with young people with care experience.