Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

Sexual and reproductive health policies for foster youth in California: A qualitative study of child welfare professionals' experiences and perceptions of policies

Child welfare professionals and foster parents increasingly suggest the importance of establishing clear and consistent policies and procedures to address the sexual and reproductive health of youth in foster care. The present study examines the content and context of such policies across 18 California counties through a search of publically available county policy documents, and surveys and expert interviews with child welfare professionals (N = 22). A policy framework for agenda setting and policymaking was used to guide the data collection and analysis process. Child welfare professionals were aware of multiple sources of information, support and services for foster youths' sexual and reproductive health, though few practiced in counties with formal policies that outline the resources and support that youth should receive. Participants demonstrated widespread recognition that issues of youth sexual and reproductive health were significant; posing challenges to youth, foster parents and child welfare staff. Identified policy solutions included: 1) training for social workers and foster parents; 2) collaborative partnerships with public health nurses and community providers; 3) data tracking and monitoring of outcomes to assess youth needs and evaluate the impact of programs and policies; and 4) involvement by advocacy organizations in defining problems and advocating for improved services and support for youth in care. Social workers largely perceived that support from child welfare administrators and policy leaders is necessary to prioritize this issue and initiate policy formation. Additional research is needed to further examine the impact of policy mandates on social workers, foster parents and youth in foster care.     

Parents' searches for child care and the design of information services

This article reports selected findings from a study of the process by which urban parents search for child care. Analyses of interview data indicate that (a) parents used informal sources of information to a considerably greater extent than formal sources, (b) the general pattern was to begin the search with relatives and close friends and gradually move out to more peripheral ties, (c) there does not appear to be an effective informal system of neighbors or community persons who matched parents with child care providers, and (d) there was no single or several sources that were outstanding in effectiveness for a large proportion of parents. The article sets forth implications of these data for the design of child care information and referral services in urban settings.     

“We Have to Create Family”: Aging Support Issues and Needs Among Older Lesbians

Gay and lesbian seniors are more likely to be single, live alone, and be childless. The current evidence base suggests that limited social supports are associated with a variety of health disparities among all older adults. Research regarding the aging issues of lesbian seniors is scarce. This instrumental collective case study of 4 older lesbians (ages 59 and older) illustrates unique aging support concerns, issues, and needs. The purpose of the case study is to increase provider sensitivity and provide supportive evidence of the need for more research. Findings suggest that limited biological family support, childlessness, and “families of choice” may be important factors in support service and health care decisions for older lesbians. Implications for care providers in working with the older lesbian population include exploring existing supports and assisting with the formation of culturally acceptable support systems and services. Given the current evidence base regarding the impact of social support on elder health, it is critical for providers to have a better understanding of elder lesbians’ unique concerns and needs relating to support and health care services in order to prevent health disparities among this vulnerable population.     

The Impact of Formal and Informal Respite Care on Foster,Adoptive, and Kinship Parents Caring for Children Involved in the Child Welfare System

This paper reports the results of a quantitative 42-item survey that explored foster, adoptive, and kinship parents’ (N = 160) utilization of different types of respite services (formal, informal, and a mixture of formal and informal), as well as their impressions of the impact of respite care on aspects of their lives related to family cohesion and stability, caring for their children, and their personal wellbeing. An exploratory cross-sectional, survey design was used to assess both the formal and informal respite care experiences of the foster, adoptive, and kinship caregivers. Two-tailed Fisher’s exact tests were used to examine the relationship between the type of respite received and caregivers’ respite experiences. Findings indicated that parent experiences differed depending on the type of respite services they received. Specifically, parents who used a mixture of formal and informal respite reported positive experiences related to respite more frequently than the other two types of respite groups, while those who received only informal respite reported less benefit than others. Parents who used formal respite (either alone or mixed with informal respite) reported greater stress reduction. The greatest increase in family stability was reported by parents who received a mix of informal and formal respite. While this study revealed clear benefits for families to using both informal and formal respite services, the findings suggest that formal respite care was helpful to parents regardless of whether used alone or in combination with informal care.     

Social Support and the Mental Health of Family Caregivers: Sons and Daughters Caring for Aging Parents in Japan

The prevalence of depressive symptoms among family caregivers has been documented as a serious social problem that could threaten the lives of the elderly and their family caregivers. Social support is considered to be a promising remedy for this problem, although a comprehensive examination of the availability and effectiveness of social support that includes both formal and informal support across multiple dimensions remains limited. In addition, little research has been conducted in Japan on gender differences in stress processes. This study tried to fill those gaps by analyzing recent survey data on sons and daughters who are caring for their elderly parents. The results indicate that sons and daughters have similar levels of formal and informal support for daily care and advice, while there are some gender differences in regard to the availability of other types of social support. It was also found that many types of informal support were significantly associated with a lower caregiver burden for daughters, although this was not necessarily the case for formal support. General instrumental support from formal sources was even associated with higher levels of distress. For sons acting as caregivers, daily caregiving support was the only formal support that was significantly associated with their lower level of distress. Issues of formal support are discussed, in order to reduce the psychological burdens borne by sons and daughters who care for their parents at home.     

“No Matter What I Do They Still Want Their Family”: Stressors for African American Grandparents and Other Relatives

Grandparents and other relatives increasingly assume the role of primary caregiver to minor children. This study interviewed family members caring for children whose parents were not available due to parental incarceration, other involvement in the criminal justice system, and substance abuse-related issues. Interviews with 25 African American women examined the impact of caregiving including stress and depression. Stress included caregiver issues related to finances, time allocation, care responsibilities, and concerns about the absent parent, as well as issues specific to the children related to school concerns, child behavior, and emotional problems. These stresses were examined along with caregiver depression scores using the Center for Epidemiological Studies Depression Scale, which indicated more depression related to caregiver illnesses, older caregivers, and care for older and a larger number of children. This study suggests that caring for these children is both challenging and stressful, and caregivers are at risk for depression and other mental health concerns. Health and service providers should carefully assess the needs of caregivers when determining the needs of families where children are under care of nonparental relatives. Family-based services are needed that include caregiver supports as well as support for children.     

Rural Mothers’ Use of Formal Programs and Informal Social Supports to Meet Family Food Needs: A Mixed Methods Study

Much of the research on low-income families, welfare, and self-sufficiency has focused on urban populations. Further, many of the studies on informal or social support available to and accessed by low-income families addressed needs such as childcare, transportation, money, or housing and did not focus on food issues. This paper focuses on how formal government food assistance programs and informal supports are utilized by rural low-income families as they work to meet their food needs. Drawing on interviews from the multi-state “Rural Families Speak” project, we examine food security in relation to the use of formal and informal supports. Additional analyses address how mothers view and describe their use of support to meet food needs.     

The need for empathy in the hospital experience of older adults

As health care has become increasingly sophisticated, health care providers struggle to ensure that patients do not become isolated and overwhelmed with the many specialists, support personnel, and technology they encounter in their hospital experiences. Hospitalized older patients often have complex diagnoses and pain issues and may have fewer external supports than younger patients. Nurses may find a renewed focus on empathy valuable in enriching health care experiences for hospitalized older adults.     

Influence of form and timing of social support on parental outcomes of a child-maltreatment prevention program

This study examines how the form of social support (informal or formal) and the time frame at which it is provided (at the start or end of the program) influence parental outcomes on the “Apoyo Personal y Familiar” (APF) program for at-risk families showing inadequate child-rearing practices. A total of 496 parents participated, 247 parents referred by the municipal social services in the Autonomous Community of Castile and Leon (Spain), and 249 non-referred parents. Initial and final levels of use of and satisfaction with informal and formal support were used as predictors of change scores in self-rating measures of beliefs about child development, perceptions of the parental role and child-rearing practices, applying hierarchical linear regression analyses. Perceived use of and satisfaction with support explained around 22% to 49% of the change scores in the Nurturist belief as a simple view of child development, Couple agreement on educational matters, Permissive–neglectful practices and Coercion practices, after accounting for the variance due to risk status, financial situation and family structure variables. Informal support always has a positive impact irrespective of when the help is provided, whereas formal support only has a positive impact when applied at the start of the program. The adequate provision of social supports can be an efficient way to prevent child maltreatment by promoting changes in parental beliefs and practices related to at-risk parenting.     

Sharon: A self-employed lone parent with a disabled child

Sharon's story was collected as part of a study of parents combining employment with the care of disabled children in Britain. Sharon is a lone parent with three daughters, one of whom, Helen, has severe epilepsy. Here she explains to researcher, Trish Heaton why work is important to her but also why it is so difficult for her to sustain work and caring in the context of minimal formal or informal support from within the community. The practical and emotional difficulties of negotiating with inflexible services can drive working parents to crisis point. Sharon describes one such crisis point where all her arrangements had broken down. The supports she needed were minimal, but their absence had a profound impact.     

Needs and Perceptions of LGBTQ Caregivers: The Challenges of Services and Support

Increasing attention has been paid to the lack of services and support afforded older lesbian, gay, bisexual, transgender, and queer (LGBTQ) women in same-sex relationships, including caregivers. This study was designed to investigate the needs and perceptions of LGBTQ women from ages 35 to 91, including informal caregivers and older adults regarding services and support from health care providers. Questionnaires were completed by older LGBTQ women (N = 76), and follow-up interviews were conducted with 25% of caregiver respondents. The majority of subjects indicated a fear of future challenges and discrimination. Four main themes emerged when analyzing the open-ended responses: the need for health care workers who were both supportive and knowledgeable about LGBTQ issues; better and consistent recognition of same-sex partners and their rights to make decisions as primary caregivers; increased sensitivity training regarding the needs of LGBTQ patients and caregivers; and more open and accepting environments where LGBTQ patients and caregivers could feel comfortable discussing issues with the staff.     

Informal care substitution: what we don't know can hurt us

Empirical studies focusing on the relationship between formal and informal home care do little to quell the fears of policymakers that expanded access to public home care services will result in the withdrawal of informal support. A close examination of the studies designed to measure the withdrawal of informal support justifies this skepticism. Concerns about the withdrawal of informal care may hinder the introduction of more extensive home care benefits. Researchers have come some distance in trying to address this policy question. The conflicting nature of empirical findings, thus far, demonstrates that the answer depends heavily on how the question is framed, how home care is measured and over what time frame, and what sorts of analytic approaches are used to model the relationship between formal and informal community-based care. This article discusses these issues in greater detail and suggests strategies to address these problems in future research.     

Informal Care Substitution:

Empirical studies focusing on the relationships between formal and informal home care do little to quell the fears of policymakers that expanded access to public home care services will result in the withdrawal of informal support. A close examination of the studies designed to measure the withdrawal of informal support justifies this skepticism. Concerns about the withdrawal of informal care may hinder the introduction of more extensive home care benefits. Researchers have come some distance in trying to address this policy question. The conflicting nature of empirical findings, thus far, demonstrates that the answer depends heavily on how the question is framed, how home care is measured and over what time frame, and what sorts of analytic approaches are used to model the relationship between formal and informal community-based care. This article discusses these issues in greater detail and suggests strategies to address these problems in future research.     

A qualitative look at child care selection among rural welfare-to-work participants

The welfare reforms of 1996 changed the administration of public assistance to children and families. One of the key provisions, requiring parents to join the workforce, resulted in an expanded need for child care. Prior research demonstrates that welfare recipients, particularly in rural areas, utilize informal child care arrangements. Further, recipients in rural communities face greater challenges due to a lack of transportation, geographic spread, and less access to services. This qualitative study examined the child care selection experiences of 33 welfare recipients in six rural Northern California counties. More families selected home-based than center-based child care. During their search processes, welfare recipients utilized both formal and informal routes to locate child care providers. Parents took advantage of their connections with the social service system, but also accessed their social networks for recommendations. Rural families also reported that their choices were constrained by the available programs, transportation, and by the quality of the programs they were able to access. Given the high rate of utilization of home-based arrangements among families in welfare-to-work programs, quality of care in such programs should be improved. Recommendations for increasing quality and access, as well as supports for welfare to work participants, are discussed.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

Childcare and parental work schedules: a comparison of childcare arrangements among Finnish,British and Dutch dual-earner families

This study examined the association between parental work schedules and non-parental childcare arrangements among dual-earner families in Finland, the Netherlands and the UK. Data from the ‘Families 24/7’ web survey were used, including 937 parents with children aged 0–12 years. Results showed a negative association between non-standard work and formal childcare across all countries. A similar association was found for using a combination of formal and informal childcare, whereas solely using informal childcare was not associated with work characteristics. Country differences showed that, compared with Finland, the probability of using formal childcare was lower in the Netherlands, whereas the probability of using informal childcare was higher in the UK. Interaction effects showed that the negative association between non-standard work and formal childcare was stronger in the Netherlands, compared with Finland. Also, the positive association between working hours and formal childcare was weaker for Dutch and British parents. This study identified the challenges that parents face when arranging childcare outside of office hours. Although the supply of formal childcare seems to be insufficient, using informal childcare introduces other potential problems. Because a considerable proportion of employees work non-standard hours, governments should help these parents in meeting their need for high quality childcare.     

Foster parents exposed to political violence: The role of social support in addressing emotional and functional difficulties

BackgroundBeing a foster parent is stressful. It becomes even more stressful when foster parents face major threats to their own families and to the foster children in their care, such as during war situations. This study focuses on foster parents' reactions to the war with Gaza in southern Israel that took place in 2014. The first goal of this study was to describe posttraumatic symptoms (PTS) and problems in functioning among foster parents following their exposure to the war. The second goal was to identify background and social support predictors of PTS and functioning problems among these parents. The third goal was to examine the role of formal and informal support received by the parents as a moderator of the association between exposure to war events and PTS and problems in functioning.MethodsParticipants were 354 Israeli foster parents who were exposed to the war. Participants completed structured instruments of exposure to war events, PTS, functioning, and social support.ResultsExposure to war events was associated with PTS and related functioning problems. Education and religiosity were correlated with PTS and problems in functioning. Contrary to our hypothesis, more formal social support was associated with more PTS. Social support did not moderate the association between exposure to war events and PTS.DiscussionThe unexpected positive correlation between support and PTS was interpreted as either reflecting the fact that foster care agencies targeted foster parents who were most in need, or as a reflection of the inadequacy of the support they received. The findings indicate that foster parents need support during times of major stressful events such as natural disasters and wars, so that they will be able to help the children in their care. Specialized professional training for foster care workers needs to be implemented. Future longitudinal and mix-methods studies are suggested to help address the limitations of the present study.     

Child Care “Packaging” Among TANF Recipients: Implications for Social Work

This article reports the results of a study that examined the ways in which current and recent TANF recipients assembled or “packaged” their child care arrangements among formal and informal providers. The findings are drawn from in-person, in-depth interviews with current and former welfare recipients. The study found that most of the respondents used multiple providers within the category of informal child care for reasons including availability, the use of a network of social acquaintances as a problem-solving resource, the need to accommodate irregular work hours, and personal trauma that contributed to a distrust of strangers in formal settings. The findings can affect the efficacy of practice with TANF recipients by contributing to social workers’ understanding of the context of decision-making regarding child care.     

Help seeking among addicted and nonaddicted women of low socioeconomic status

Concern with the provision of health and welfare services to underserved or inappropriately served groups has led to numerous studies of patterns of service utilization. This article focuses on the help-seeking patterns of heroin-addicted and nonaddicted women of lower socioeconomic status. The results suggest addicts generally experience more problems than nonaddicts; those with few problems are less likely to use formal support systems; and black respondents, both addicts and nonaddicts, are less likely to use formal support systems. The evidence indicates that while addicts tend to use natural support systems less frequently than nonaddicts, addiction per se does not explain help seeking when race and number of problems are taken into account. The heavy reliance of both addicts and nonaddicts on informal helpers supports the value of professional efforts designed to facilitate or enhance these networks.