‘Who do I turn to if something really bad happens?’ Key working and relationship-based practice in residential child care

ABSTRACT

This article explores the psychodynamics of relationship-based practice from the perspective of young people in residential care. This research involved qualitative semi-structured interviews with 10 care leavers, aged 18–24 years, who had been in residential care in Ireland. Drawing selectively from that research, this article reports their views and experiences of key-working and how relationship-based practice acted as a reparative method within their experiences of care and aftercare. Similar to previous research, this study underscores the necessity to ensure that children in care are cared for and supported by a trusted adult. In addition, based on this study, the role of a key worker appears capable of providing this ideal type of supportive relationship. It also highlights the importance of the care system working to provide consistency and support for the young people and confirms the importance of relationships with trusted adults, such as key workers.     

Australian Approaches to Resident Classification and Quality Assurance in Residential Care

Summary

This paper begins with an account of the structure of Australia's residential long-term care program, which was divided into two distinct levels of hostel and nursing home care until 1997. In response to changed policy objectives, a number of measures were then taken to create an integrated residential care system. The main measures were the development of a single scale for classification of resident care need and associated funding to replace two previous separate scales, and the implementation of a new quality assurance system, which included new standards for buildings as well as revised standards for care. I give accounts of these measures and the extent to which they have achieved their intended outcomes before proposing some further developments that could see closer links among pre-admission assessment, resident classification, and quality assurance.     

Where can I mourn? Psychodynamic contributions to working in residential child care

ABSTRACT

Loss permeates the experience of being placed in residential child care, yet residential workers are rarely trained to work with young people who are grieving the loss of family and home. This article will provide an overview of psychodynamic theories of mourning, and will discuss how grief work can be facilitated for children and youth in residential child care.     

Disability and Abuse in Relation to Substance Abuse

Abstract

This analysis reviewed five years of a state's substance abuse treatment admissions and discharges in order to identify specific patterns among persons who had a disability. Using a series of group comparisons, Chi-squares, and logistic regressions, specific patterns of violence and abuse to this population were identified. Results indicate that persons who had a disability and abused substances were more likely to be victimized by physical abuse and domestic violence when compared with their peers without a disability. A person with a disability had about one-half to one-third the odds of receiving long-term residential, short-term residential and intensive outpatient care when compared with persons without a disability.     

Family Functioning and Satisfaction of Former Residents of a Non-Therapeutic Residential Care Facility: An Exploratory Study

ABSTRACT

Recently there has been a resurgence in discussions among government policy-makers regarding the use of non-therapeutic residential care as an alternative to kinship and family foster care. If informed decisions are to be made regarding foster care alternatives, evaluation is needed of how children fare in residential care facilities. This study looks at the family relationships and life satisfaction of 76 adults who resided in a residential care facility as children. The overall positive results suggest that the negative reputation of non-therapeutic residential care facilities may not be wholly deserved. The authors hope that this information can assist social workers and policy-makers in making important decisions about the appropriate use of residential care with our country's future population of foster care children.     

Adoption of an Outdoor Residential Hall Smoking Policy in a California Public University: A Case Study

Abstract

Objective: Because secondhand smoke is a public health concern, many colleges have adopted bans to ensure healthier environments. This study demonstrates how outdoor smoking policy change can be accomplished at a large public university. Participants: The participants were 1,537 students housed in residential communities at the University of California, Berkeley, who completed an online survey. Methods: A proposal for smoke-free residential communities that included student resident survey data was prepared. Results: The survey data indicated that most students (77%) were bothered by secondhand smoke, and most (66%) favored smoke-free environments. The data were used to advocate for a change in the residential community smoking policy. Conclusion: The survey data and institutional comparisons played a key role in administrators’ decision-making about campus smoking policy. Despite administrators’ concerns about students’ safety and freedom of choice, student-led advocacy was able to influence policy change.     

Recent Developments in Aged Care Policy in Australia

Summary

A series of major reforms implemented through the mid 1980s sought to contain residential care and expand community care in Australia's long-term care system. While this goal has been maintained, a number of new policy initiatives followed the change of federal government in 1996. This article presents a systematic account of current policy objectives, implementation measures, and outcomes in three major policy areas: changing the balance between residential and community care, targeting in community care, and support for family caregivers. This analysis shows that while there have been shifts in emphasis from time to time, concerted policy efforts over the last 20 years have contained the growth of expenditure on long-term care and realized significant change in the service system.     

Some aspects of a Housing Officer's work

Abstract

This paper reviews the benefits claimed to flow from the commencement of the Aged Care Act 1997. It is concluded that in restructuring residential aged care services the Commonwealth Government has withdrawn from its regulatory responsibility of ensuring residents receive adequate standards of care. To legitimate its actions the Government contractualised the relationship between service providers and residents, to the detriment of the residents.     

Changing Needs and Changing Service Delivery for Long-Term Care in Hong Kong

Summary

Both the need for and delivery of long-term care in Hong Kong are shaped by the interaction of the traditional and modern. Rapid social change is affecting traditional family structures and roles in care of the elderly, resulting in increased demand for formal care, which to date has been provided mainly by way of residential care. This growth of demand will escalate with rapid population aging in coming decades. In response to this burgeoning demand, current planning is seeking to reshape the established service system and tackle problems in service delivery in ways that will address the bias towards residential care and improve quality of care.     

Older lesbians' experiences with home care: Varying levels of disclosure and discrimination

ABSTRACT

There is considerable evidence that lesbian, gay, bisexual and transgender (LGBT) older adults have experienced barriers to health care access and have profound fears about how they will be treated in the long-term care system, but the specific experiences of older lesbians have received less attention. Most older adults needing long-term services and supports (LTSS) prefer to remain at home, and this is true for lesbians as well. This article reports on a national, qualitative study of the experiences of 20 older lesbians (age 65 and older) with home care workers. The experiences of six informal partner caregivers with home care services are also included. Emergent themes regarding level of disclosure, experiences with homophobia, evaluation of care received, and thoughts about ideal LTSS are described. Most study participants did not disclose their sexual orientation to their home care workers. A significant minority experienced homophobia, but nearly all ultimately found workers who provided good care with which they were comfortable. Their visions of ideal LTSS included greater affordability and particular qualities that were important for home care workers to possess, such as competence, caring and acceptance. Practice and policy implications are outlined including careful recruitment, training and supervision of home care workers to foster lesbian-sensitive care, but also improved wages and work conditions in order to maintain a quality home care workforce.     

A longitudinal study of children’s outcomes in a residential special school

ABSTRACT

This study presents findings from a longitudinal study of the Mulberry Bush School (MBS), a therapeutic residential special school in England which provides an integrated approach to education and care for children aged between 5 and 13 years. Four cohorts were followed (23 = boys; 13 = girls), each for a consecutive 3-year period, approximating children’s time at the MBS. Children showed significant improvements in their socio-emotional, behavioural and academic development. The picture is more mixed for children’s attachment representations, which might be expected of the vulnerable and severely traumatised children who make up the MBS population. The importance of these improvements stem from the fact that they were achieved in the face of the exceptional disadvantages and challenges that characterise the lives of all children who attend the MBS. This is testimony to their achievement, and to the potential of the residential special school as a therapeutic learning environment.     

Vertical Axes on the Long-Term Care Continuum

Abstract

As the continuum of long-term care has expanded, public funding has not accompanied new care options. I detail access, provider profits and resources, and care quality in two types of residential care that fall in the center of the continuum, assisted living and board and care. These two options provide examples of how limited public funding leads to vertical axes, which represent access to services, the resources providers draw on to give care, and the quality of long-term care services, at each service point on the long-term care continuum.     

Chapter 3 Residential Care Facilities for the Elderly

Abstract

Residential Care Facilities for the Elderly (RCFEs), known as board and care homes, are licensed in California and many other states for non-medical care in the community. RCFEs are examined here to provide illustrative issues in the definition of types of long-term residential care. The research examines physical functioning, social supports, and course of residential placement for 109 RCFE residents (mean age 84 years). A significant portion of the residents had personal assistance needs not usually provided at the RCFE level (75% assistance with medication, 52% used walking aids, 29% assistance in bathing). Additionally, a third of the residents had restricted social supports and social activity. Residents report declines in functioning and support as reasons for moving to residential care. Length of residence in the facility (range less than a year to 15 years) was not related to physical functioning or social activity. These findings do not support “aging in place,” within the facility, as the rationale for increased need for assistance in residential care. Implications include the need to maintain the social model of residential care ample for the majority of residents while assuring the availability of a higher need for assistance of a significant portion of the residential care population.     

The Kids Say Project: Supporting Children to Talk about their Experiences and to Engage in Decision-making

Research and policy calls for hearing the voices of children and youth in out-of-home care and involving them in decisions about their own lives. The “Kids Say” cards were designed to facilitate this engagement, particularly with Indigenous children and youth. A feasibility study explored the extent to which the Kids Say cards were acceptable to young people, and prompted discussion about their lives and what is important to them. The study involved 47 participants, aged 7 to 18 years, from three cultural groups: Aboriginal n?=?20; culturally and linguistically diverse (CALD) n?=?10; non-Indigenous English-speaking n?=?17. The cards were found to be appealing to all three groups, and to facilitate child and youth voice. Findings also did not differ significantly according to gender or age. These preliminary findings indicate the potential value of appropriate practice tools to support children and youth to share their experiences and participate in decision-making.

IMPLICATIONS

• Engaging resources, such as the Kids Say resource, are potentially valuable in supporting practitioners to encourage children and young people to share their experiences and participate in decision-making about their own care and service needs.

• Training in creating safe sharing contexts for children and young people is essential. While emphasis is often given to gathering child voices, there is a need for at least equal emphasis on respectful adult listening.

     

Family members’ experiences and management of resident-to-resident abuse in long-term residential care

ABSTRACT

Objectives: Resident-to-resident (RRA) abuse is increasingly recognized as a significant problem in long-term residential care.Families have a constant presence in this setting, yet their inclusion in research about RRA is minimal. The purpose of this study was to examine family members’ experiences and management of RRA. Methods: The methodology was critical ethnography.Twelve family members participated in in-depth interviews and 56 hours of participant observation were conducted. Data were analyzed thematically. Results: The main themes illuminate families’ experiences of RRA in a context that largely normalizes it.In the absence of formal supports, families developed a range of management strategies, ranging from passive to active intervention.Organizational factors, such as staffing levels and mix, and the physical environment also contributed to RRA. Discussion: Families are actively managing RRA in long-term residential care. Policies and programs, including educational supports, should be developed to validate and support families.     

The role of religion in mediating the transition to residential care

PurposeThe move from independent domicile to residential care can be a traumatic experience for the elderly. This study investigated the mediatory role of the individual's religious and spiritual beliefs on coping with this transition.Design and methodsA self-report survey design was used, and questionnaires were administered to 50 individuals who had entered residential care within the previous 12 months.ResultsThe analyses showed that scores on a life satisfaction scale were significantly and positively correlated with those from a spirituality measure (p = .033), from a faith in nature and humanity scale (p = .001), and from an instrument to measure the use of religion as a coping measure (p = .004). Contrary to the hypotheses, there were no such significant relationships with measures of either organised or non-organised religion. The relationships between variables were further explored through a path analysis.ImplicationsThe findings pointed to the benefits of a more personal and subjective belief system than a formal one. We concluded that it is important for all those who work with the elderly to acknowledge and recognise the role that religious and spiritual beliefs may have as a coping mechanism during stressful times.     

Évaluation du rattrapage de la croissance chez les garçon d'âge préscolaire ayant souffert pendant une longue période de négligence et de maltraitance psychologique

Objective. To assess the catch-up growth of long-term physically neglected and emotionally abused preschool male children who have entered foster residential care and remained 1 year after initial placement.Method. Longitudinal study over a 7-year period (1994–2001). So that a child was eligible for the study, three selection criteria were included: (1) aged between 24 and 48 months at the time of entry into residential facility, (2) having sufffered both long-term (more than 6 months) physically neglected and emotionally abused, and (3) having stayed in foster care for 1 year after initial placement. Weight, height, and head circumference were established upon entry and re-assessed 1 year after initial placement, calculating the annual growth velocity. Results were compared with normal regional longitudinal standards of reference (Z score). Student's t test was used to assess statistically significant differences.Results. During the study perior, 87 children aged between 24 and 48 months (54 male/33 female) were admitted to residential facility after having suffered both long-term physical neglect and emotional abuse. Nevertheless, only 20 children (23 % of the total admissions) met the third selection criteria (having remained 1 year after initial placement). Of these children, all were males and at placement they were between the ages of 30 and 42 months, with an average age of 36 months (1.9 SD). At placement, the analysed parameters were below the normal standards, showing a statistically significant differences for height (Z score - −1.29; p = .008) and weight (Z score = − .75; p = .038). The annual growth velocity for all parameters was above the normal standards showing a statistically significant difference for height (Z score + 1.43; p = .009). One year after initial placement, the significant differences for height (Z score = 68; p = .102) and weight (Z score 31; p = .435) with respect to the normal standards disappeared, though still remained below, showing a significant catch-up growth for height (improvement height Z = +.61 SD).Conclusions. At placement, the both long-term physically neglected and emotionally abused preschool age male children showed a mild form of chronic malnutrition with growth failure was reversible after the first year of stay, which demonstrates that this delay in growth was secondary to nutritional and psychosocial factors. Placement in foster residential care was beneficial for the catch-up growth of these patients.     

Frequency and Types of Partner Violence Among Mexican American College Women

Objective and Participants: The authors studied the prevalence of partner violence, by type, among Mexican American college women aged 18 to 35 years (N = 149; response rate = 85%). Results: Twelve percent of women who reported a dating partner in the past year were physically or sexually assaulted, 12.1% were stalked, and 9.1% scored as psychologically abused. Among those experiencing partner violence, almost half experienced stalking and 89% reported psychological abuse. Few women (25%) who experienced physical violence believed violence was a problem in their relationship. Conclusions: Partner violence was prevalent in this population, and participants experienced many forms of violence. Because few women experiencing physical violence report that violence is a problem in their relationship, interventions must address perceptions of violence and its impact on women's mental and physical health in college populations.     

Personalisation,social justice and social work: a reply to Simon Duffy

This paper begins by defining what is meant by adolescence and reviewing the literature which indicates concern for the high rates of suicidal behaviour in adolescence. Possible explanations as to why adolescents harm themselves are considered, as is the contagious aspect of some suicidal behaviours. Extracts from three interviews conducted with young women in residential care who have engaged in self-harming behaviours are then considered. Links are made between what they say and relevant theory. The paper goes on to discuss the impact of suicidal behaviour in residential care settings. It concludes that it is essential to create time and space to think carefully about this complex and multi-faceted difficulty both for the adolescents themselves and those in the caring professions charged with the responsibility of trying to help them.