'The past, the present, but never the future': thematic representations of fostering disruption

The paper discusses some of the findings of a small-scale explor-atory research project which analysed the dynamics involved in substitute family care placements for young people, and assessed the processes demonstrated in fostering breakdowns in terms of the interactions, negotiations and adjustments between the re-spective parties over time. The paper concentrates on three core and interlocking themes: first, the perception of foster placements as 'second best'; secondly, the 'images of family life' permeating placements; and finally, the 'nature vs. nurture' debate which affected the ability of users and carers to sustain placements. These themes were selected for their significance in the development of an explanatory framework for understanding the interactional dynamics involved in placement disruption. The paper concludes with a discussion of the key implications for social work practice, considering foster carer training, sustaining placements, and part-nership arrangements between the young people, their natural families, foster carers and social work professionals.     

Broken circles to a different identity: an exploration of identity for children in out–of-home care in Queensland, Australia

Child protection manuals and literature emphasize that developing a sense of identity is one of the most important elements in achieving good outcomes for children in out-of-home care. Yet, the very issue of identity raises questions that many child protection workers are ill-equipped to answer. In practice, life story book work based on developmental theories has been utilized by child protection workers and foster carers as a response to a sense of 'lost identity' for children in out-of-home care. However, Indigenous and psychological concepts of identity may have little in common.
Current theories of identity development in children lack evidence from the children and young people themselves in informing these notions, which have been criticized as adult-centric. Developmental theories may also be problematic for children from non-Western cultural groups. This research was undertaken in a regional area of Queensland, Australia where the majority of children in the child protection system who are identified as Indigenous, come from two or more cultural backgrounds. The research presented in this paper firstly explores identity issues for children and young people in foster care from their own perspective using narrative art therapy. Secondly, the research views identity from the perspective of professionals working in child protection and out-of-home care.     

Improving outcomes for children in out‐of‐home care: the role of therapeutic foster care

How best to support children and young people in foster care remains a challenge for child welfare. There has been little Australian research on the outcomes for children and young people placed in therapeutic foster care (TFC). This article aims to address this knowledge gap, presenting the evaluation of a state‐wide model of TFC known as the Circle Program operating in Victoria, Australia. Data sources for the study were case assessment analysis; surveys of foster carers, program workers and other stakeholders in the sector; and both focus groups and individual interviews with foster care workers. The evaluation found that the Circle Program lessened the number of unplanned exits of children from foster placements compared with generalist foster care. Another important finding was that the Circle Program positively influenced foster carers' decisions to stay in the carer role. Key components perceived as contributing to outcomes of the Circle Program included enhanced training of foster carers, intensive carer support, specialist therapeutic support to the child and carer, therapeutic service to family members and a network of services to provide support to the child.     

“The Poor Carer”: Ambivalent Social Construction of the Home Care Worker in Elder Care Services

In this article, we examine the social construction of the home care worker from the perspective of various professionals in the elder care sector in Ireland. The research, using the Grounded Theory method, involved focus groups with 31 participants comprising health and social work professionals as well as care agency managers and policy planners. The social construction of the elder care worker is characterised by ambivalence. We connect the concept of ambivalence at the micro level of human relationships to structural factors that are driving the ambivalence. Ambivalence towards home care workers is shaped by structural factors including the precariousness of care work, the commodification of time, and the stipulated personalisation of services. The irreconcilable contrasts between portrayals of care workers as both ‘good’ and ‘bad’ are indicative of deep contradictions in the expectations that contemporary care systems direct at paid caregivers. Ambivalence arises from the commodified and dispensable status of care workers, and fundamental transformations in their training, working conditions and pay are required to move away from this ambivalence and towards care workers’ equal status with professionals in the care sector.     

The Right to Take Risks: Alcohol and Older People

This paper examines policy and practice regarding the purchase of alcohol for older clients of home carers in three local authorities in the Greater London area. Data were gathered from interviews with home carers and their managers, focus group discussions, and a postal survey. None of the local authorities had a written policy or written guidance on alcohol purchase or on appropriate responses to the identification of problematic drinking in older clients. The findings illustrate the problem of balancing "rights" and "risks" within a philosophy of community care which emphasizes client choice and autonomy, and show how policy and practice are "tailored" by local contexts. It is suggested that both home carers and other domiciliary workers, as well as their older clients, could benefit from a clear code of practice regarding responses to alcohol consumption and problematic drinking by older people.     

Providing a secure base for LGBTQ young people in foster care: The role of foster carers

The experiences and needs of lesbian, gay, bisexual, trans and queer/questioning (LGBTQ) young people in care have been overlooked in England, in both policy and research. This paper reports on findings from the first study of LGBTQ young people in care in England and focuses on the nature of foster carers' experiences and perspectives on caring for LGBTQ young people. Qualitative interviews regarding the fostering role in caring for LGBTQ young people were conducted with a sample of foster carers (n = 26) and analysed thematically. Foster carers described the importance of offering LGBTQ young people not only the nurturing relationships that all children in care need but also availability, sensitivity and acceptance to help young people manage stigma and other challenges associated with minority sexual orientation and gender identity. The Secure Base caregiving model provided a framework for analysing the different dimensions of these relationships. Understanding caregiving roles and relationships for LGBTQ young people in care has important implications for recruiting, training, matching and supporting foster carers to care for LGBTQ young people effectively.     

It's frustrating! Managing emotional dissonance in aged care work

Performing paid care work requires workers to simultaneously negotiate care and waged relationships. Mediating contradictions between the two often causes workers to experience frustration, a form of emotional dissonance. Drawing on semi‐structured interviews with 100 workers in Australian aged care organisations, this research identifies aspects of the work environment that enable care workers to successfully juggle or synthesise the emotional demands of their work. The research demonstrates that employers have an important role in alleviating frustration, and can do this by creating work environments which: give care workers relative autonomy; allow care workers to construct themselves as professional carers providing quality care; provide workers with support to manage their emotions and develop emotional resilience; and promote client recognition of workers' roles. Providing such work environments has the potential to not only alleviate workers' frustration, but also to increase job satisfaction and retain workers in aged care.     

Well‐being among employed and non‐employed caregiving women in Taiwan

Chou Y‐C, Kröger T, Chiao C, Pu C‐Y. Well‐being among employed and non‐employed caregiving women in Taiwan This study addressed various groups of non‐employed/employed and non‐caring/caring women in Taiwan. Data from the 2006 National Taiwanese Women Survey (at age 16–64, n= 6,017) were analysed to determine whether there are differences in terms of well‐being, as measured by self‐rated health and family life satisfaction, between women who work and/or care and between different carer groups. Other factors associated with well‐being of carers of young children (n= 1,697) were also analysed. The results showed that non‐employed carers of disabled adults stood out as the most disadvantaged group. However, the importance of work has been replaced by support among carers of young children. This study suggests that unpaid carers, particularly carers of disabled adults who are non‐employed, ought to be supported by policies. To improve carers' well‐being, care–work reconciliation among working‐age women needs to be included in the future care scheme in Taiwan.     

Income support for Australian carers since 1983: social justice,social investment and the cloak of gender neutrality

Income support for carers has been available in Australia since the early 1980s. In contrast to most other forms of income support, eligibility for Carer Payment has been progressively expanded in recent years, and increasing numbers of carers are claiming the payment as a result. This article examines the history of income support for carers by reviewing changes in eligibility criteria in the social security legislation and considering how those changes were framed. We argue that reforms to carers' income support have developed within competing frames of social justice and social investment, with an increasing emphasis on a social investment discourse, which prioritises paid work over care. Neither of the dominant frames addresses gender equality, and in practice, income support policy has reinforced familial (women's) responsibility for caring. Given the gendered nature of caring in Australia, gender equality issues must be considered in future policy reforms to ensure that the competing pressures on women to care and to engage in paid work do not lead to greater disadvantage and inequality for women and the people for whom they care.     

Challenging Professional Roles: Lay Carers' Involvement in Health Care in the Community

The bulk of care in the community is carried out by lay carers. Recent policy initiatives to support them in the United Kingdom are outlined. There remains evidence of significant gaps in support from professional health and social‐care workers including community nurses. This paper reports three studies of lay carers: those caring for older people, carers of technology‐dependent children, and home‐care workers involved in the “direct payments” scheme. Findings are reported in the areas of decisions about appropriate caring roles, the lay–professional boundary, training and respite opportunities and the expertise of lay carers. Recommendations for policy and practices are made.     

Community Mental Health Services in a Remote Rural Area

A programme was developed by the authors to provide community mental health services to an isolated rural region situated within the large catchment area of a state psychiatric hospital. The programme functioned without psychiatrist or medical officer in the team. The authors believe their programme to be effective and economical both of monetary cost and of the scarce services of psychiatrically trained professional workers. They hope it will serve as a model for other community mental health workers.     

Charging and Quasi-Markets in Community Care: Implications for Elderly People with Dementia

Social services authorities in the UK are increasingly involved in charging and fee collection activities with clients in receipt of community care services. This article explores the implications of these developments for elderly people with dementia. The starting point of the article is a critique of existing legal and administrative options for handling other people's money, including the difficulties and dilemmas raised for both paid and unpaid carers by the existing arrangements. This is then related to the failure of charging and fee collection systems which have developed as a result of the community care reforms to address the particular needs of elderly people with dementia. A case study of policies in one local authority is outlined and this is followed by the presentation of the view of 37 fieldlevel professionals who were interviewed in focus groups. The concerns of these respondents included the complexity of the assessment task, conflicts between care managers and finance/revenue staff, the difficulty of defining and responding to financial abuse, and dilemmas over the extent to which relatives and carers should be trusted. The final section of the article considers the implications of a move to quasi-markets in social care for elderly people with dementia, particularly in terms of their vulnerability to financial exploitation.     

INTERPERSONAL SKILL TRAINING FOR SOCIAL WORKERS IN SMALL GROUPS

This study evaluates the effectiveness of a small-group training program aimed at teaching social workers those interpersonal skills necessary for effective practice. Participants were taught to deal with critical situations commonly encountered by professional social workers in their clinical practice. Modeling, overt and covert rehearsal, videotaped and verbal feedback, coaching, behavioral assignments, delegation of group leadership, and other small group procedures were utilized in the training program. Participants met in small groups offour to six members for 2-hour sessions each week over a period of 6 weeks. The results of the study indicated that, following training, the participants were significantly (p≤ .o1) more effective than the controls in dealing with both trained and untrained items on a behavior role-play test. Methodological limitations, implications for future research on small-group training of social workers, and training of group leaders are discussed.     

The role of carers in supporting the progress of care leavers in the world of work

The aim of this component of a preliminary cross‐national study (Ireland and Catalonia) of care leavers' experience in the world of work is to explore how carers may influence the entry of young people in care into the world of work and how they may also influence the young people's progress in that world. A total of 22 care leavers, aged 23–33 years, were recruited on the basis of their having substantial employment experience since leaving care. Evidence from the interviews reveals the importance of the role of carers in the work‐related progression of the young care leavers, especially in relation to gaining work experience while they were still in care. The qualitative analysis shows that carers were influential in promoting (and sometimes hindering) progress in work and education. Carers were often reported to play an important role in opening up opportunities, giving support (modelling skill development, giving practical help, etc.), being role models and cultivating the young person's agency. On the basis of these findings, we propose an initial conceptualization of carer roles in positive work support.     

'Your friends don't understand': Invisibility and unmet need in the lives of 'young carers'

This paper is based on a study of the experiences of people identified as ‘young carers’, commissioned by the National Assembly for Wales as part of a wider review of carers’ needs and services. Following a brief review of some of the previous research in this area, the paper reports key findings of the research, using the words of children and young people as much as possible. It then goes on to explore some of the wider implications of this and other research for the identification and support of ‘young carers’ and their families, and for the understanding of the needs and wishes of children and young people so defined. The paper concludes with an alternative definition of a ‘young carer’ and with some recommendations for professional practice, suggesting that the role of social work is crucial in this area of service.     

Man-made Care: Community Care and Older Male Carers

Correspondence to Mike Fisher, Department of Social Work, University of Bristol, 8 Woodland Road, Bristol BS8 1TN. Summary Recent evidence about the extent of caring for older peopleby older people themselves, and about the importance of spousecare, has challenged existing debates about gender and care.Male carers, particularly older husbands, have been ‘discovered’.This paper attempts to reconceptualize the debate about genderand caring to take account of these developments, particularlyto develop an understanding of the caring activities of oldermale carers and to elaborate the implications for communitycare policy. The evidence suggests there are circumstances where men acceptthe obligation to care, undertake intimate personal care, andderive identity and reward from their caring work, driven bysimilar motives and experiencing similar struggles as women.Rather than seeking maximum distinction between the motivesand experiences of women and men carers, the paper suggeststhat one important way to promote non-sexist community careis to explore the conditions where men's caring is undertakenand how it can be understood and developed.     

FACTORS AFFECTING THE POST-HOSPITAL CARE PLANNING OF ELDERLY PATIENTS IN AN ACUTE CARE SETTING

Post hospital care decision making is an issue for a vast number of elder persons and yet has received little attention from social work professionals. This paper reviews literature regarding attitudes of professionals, family members and patients themselves toward decision making in a hospital context. Furthermore, an exploratory study involving 40 hospitalized elderly patients highlights the potential risk in limiting patient involvement and identifies implications for practice with the elderly.     

Combining Work and Care: Carers' Decision-making in the Context of Competing Policy Pressures

Issues related to paid work and care are of global importance, reflecting the twin pressures of population ageing and efforts to increase labour market participation. Informal carers of sick, disabled or older people can experience tensions between policies aimed at support for care and support for employment. This article discusses a study of carers’ decision‐making around work and care, drawing on evidence from interviews with 80 working‐age carers in England. Carers are not homogeneous; their circumstances and needs differ reflecting age, gender, ethnicity, labour market participation, and the condition and/or needs of the person they support. This diversity is illustrated by contrasting rural and urban carers’ decisions and experiences about work and care. Key factors that impact on carers’ decisions are: current and anticipated financial need; the constraints arising from receipt of carers’ and other means‐tested income maintenance benefits; personal identity; job opportunities and scope for flexibility; social services provision; carers’ own health. Distance, travel times and transport are unique additional challenges for rural carers who (wish to) work. These difficulties are further intensified when they intersect with other factors such as the Carer's Allowance, the local labour market and social services provision. The findings are evaluated in terms of the adequacy of current government policy measures.     

Worries and problems of young carers: issues for mental health

This paper reports on a research study which explored the worries and problems of young carers in Edinburgh. Sixty‐one young carers took part in the study, conducted between April and June 2002. Findings indicate that young carers identify significant worries and problems in relation to their well‐being, and that these come over and above any ‘normal’ adolescent difficulties. It is suggested that these findings may have important implications for young carers’ mental health, now and in the future, and contain important lessons for child and family social work in general.     

Foster carer perceptions of support and training in the context of high burden of care

The challenges of providing sensitive and structured care for children in foster care go well beyond normative experiences of parenting. The present paper describes a mixed‐methods study of foster carers' perceived need for support and training, referenced to estimates of their burden of care. Semi‐structured interviews were conducted with 17 foster carers in the Canterbury region of New Zealand. Carers' perceived need for support and training were identified through qualitative analysis of interviews using domain analysis method. Carers' burden of care was estimated from the Parenting Stress Index and from a measure of carers' encounters with children's emotional, behavioural and relationship difficulties that was designed for the present study (the Caregiver Behavioural Encounters Index). Foster carers reported substantive, unmet needs for support and training. Foster carers also reported high parenting stress and encounters with a wide range of children's mental health difficulties, including both uncommon and severe difficulties, which together represent an exceptional burden of care. Carers' highest priority need was for training and support on managing and responding to children's mental health difficulties, while their greatest existing support came from Caregiver Liaison Social Workers and other carers. The findings suggest a number of critical implications for practice.