Access to health care: does neighborhood residential instability matter?

Many Americans do not have access to adequate medical care. Previous research on this problem focuses primarily on individual-level determinants of access such as income and insurance coverage. The role of community-level factors in helping or hindering individuals in obtaining needed medical care, however, has not received much attention. We address this gap in the literature by investigating the association between neighborhood residential instability and access to health care. Using individual-level data from the 2000 Medical Expenditure Panel Survey and block-group level data from the 2000 decennial census, we find that individuals who live in neighborhoods with high residential turnover have worse health care access than residents of other neighborhoods. This association persists even when the prevalence of poverty, the supply of health care, and a variety of individual characteristics are held constant. We offer explanations for these findings and suggest directions for future research.     

‘Nothing works’ in secure residential youth care?

A debate about the effectiveness of secure residential youth care is currently going on. While some continue to support secure residential youth care, others conclude that ‘nothing works’ in secure residential youth care, and argue that non-residential treatment is superior to secure residential treatment. This article reviews recent research on this topic. The conclusion is that evidence for the effectiveness of non-residential treatment for youth with severe behavioural problems and/or criminal behaviour is sparse if considered as an alternative for secure residential youth care. Secure residential treatment shows a modest, but positive effect. We need to overhaul the myth that ‘nothing works’ in secure residential youth care, and focus on how to optimise the effects of secure residential youth care.     

Caregiver perceptions of empowerment and self-efficacy following youths’ discharge from residential care

ABSTRACT

Residential care is one of the most restrictive out-of-home care settings; however, this is a temporary placement and youth eventually reintegrate into the home and community setting. Reintegration presents many challenges, and aftercare becomes critical for maintaining youth gains and promoting family stability. Aftercare programs and supports should align to individual family needs that entail understanding individual and familial characteristics. Previous studies have explored characteristics related to family functioning, mental health, behavior, and perceptions of need during reintegration; yet little is known regarding how affective characteristics (i.e., self-efficacy, empowerment) factor into reintegration, or the implications this may have for providers. The purpose of this study was to address this gap by exploring empowerment and self-efficacy in caregivers (N = 120) who had a child return home within 1 month of departing residential care. Overall, caregivers reported high levels of empowerment and self-efficacy during the initial transition period. Significant differences for empowerment and self-efficacy were present in characteristics such as race, income, number of children in the home, and free/reduced lunch status.     

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.     

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.     

Transition secured? A follow-up study of adolescents who have left secure residential care

Many adolescents who make the transition to adulthood experience problems after their departure from secure residential care. Research suggests that these young people are often in need of support after they have left secure care. Little is known about the experiences and perceptions of adolescents during and after this transition. The aim of this article is to assess these experiences for a group of 24 adolescents in the Netherlands that have left secure residential care. The results show, in line with previous studies, that many adolescents experience problems during their transition from secure care, especially with regard to finances, school and employment, and living arrangements. In contrast to other studies, a majority of the adolescents reports to have received support in the year following their departure. Relatively few adolescents move to independence after their departure, which suggests that many adolescents are not ready for making a true transition into adulthood yet.     

Does family reunification from residential care facilities serve children's best interest? A propensity-score matching approach in Ghana

The U.N. Convention on the Rights of the Child declares that children are entitled to grow up in a family environment with love, happiness and understanding. Governments and international child welfare agencies have promoted the reintegration of children currently in residential care facilities with family or other caregivers. We assess whether 157 children who spent time in a Ghanaian residential care facility but who have been reunified with their families scored differently on a battery of standardized child wellbeing measures than 204 children still living in residential care facilities using propensity score matching models. Results suggest that outcomes, including overall hope (as well as hope pathways and hope agency) and access to basic resources as measured on the Child Status Index, differ between children who were and were not reunified. These results underline the importance of supporting children's physical and psychosocial developmental needs. Children who were reunified with family members or other kin may require additional support regarding access to basic resources whereas interventions designed to increase hope in the future may benefit children in residential care. We urge a redoubling of efforts to care for children under carefully designed national schemes providing resources, trained personnel, and sustained case management.     

‘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.     

On the frontline or on the side-line? Homelessness care and care avoiders

Homelessness is a social problem that is subject to many definitional issues and problems. These problems can be discerned on both the conceptual and the practical level. Based on research carried out in Ghent, Belgium, this article deals with ways in which social workers involved in homelessness care construe the problem of ‘care avoiders’, who seem to be perceived as a separate category within the homeless population. We show that: (1) different categories of homelessness are created on an organisational and on an individual level (2) specific services have been developed for those who do not enter regular facilities and (3) a residual group has been created, which social work does not really know how to deal with.     

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.     

Gender and the residential telephone, 1890–1940: Technologies of sociability

Recent work on gender and technology debunks the claim that household technologies have liberated women from domestic work. The history of telephone use in North America suggests, however, that global conclusions about gender and consumer technologies may be misleading. Although marketed primarily as a business instrument and secondarily as an instrument to facilitate housework, the telephone was, in a sense, appropriated by women for social and personal ends. This paper explores the affinity of women for the telephone, how women in the half-century before World War II used the telephone, and why. It suggests that there is a class of technologies that women have exploited for their own, gender-linked, social and personal ends.     

Gentrifikation in zwei Wohngebieten von KölnGentrification in two residential areas of Cologne

We examine the process of Gentrification in two residential areas of Cologne, Germany: Deutz and Mülheim. The theory underlying the study is a phase (or stage) model of Gentrification in which indicators and their values are attributed to each phase. The hypotheses derived from the model pertain to changes in the social structure, rents and the spatial distribution of social groups such as “pioneers”, “gentrifiers” and “others”. We further assume both areas to be in different phases of Gentrification.     

Who should care for our kids? The effects of infant child care on early child development

This paper examines the relationship between various types of child care during the first year of a child's life and the child's language and social development measured at age three. A unique contribution of the paper is the estimation of a general selection-correction model that accounts for non-random selection of children into different types of child care. The analysis uses data from the Fragile Families and Child Wellbeing Study (FFCWS), a birth cohort of children born to predominantly low-income single mothers. The results indicate that compared with maternal care, relative care during infancy has more beneficial effects on a child's language development, while day care centers have more beneficial effects on a child's behavioral development.     

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

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

Too close to home? The relationships between residential distance to venue and gambling outcomes

Although gambling accessibility is generally viewed as a multidimensional construct, few studies have successfully untangled the specific role of spatial accessibility in determining gambling outcomes relative to other forms (i.e. temporal, social and psychological). In this paper, we explore the association between gambling outcomes and the distance travelled from a person's home to their most-frequented gambling venue. To this end, we conducted a geocoded mail survey of 7044 households in the Northern Territory of Australia. We employed a geographic information system to calculate the network distance from each household to all visited electronic gaming machine (EGM) venues (n = 64). Multivariate regression modelling revealed that, when adjusted for individual and neighbourhood-level characteristics, frequency of venue visitation and gambling participation were inversely related to residential distance from venue. There was no additional distance effect for problem gambling. Spatial accessibility of EGMs is an important determinant of gambling risk and should be explicitly considered by regulators.     

The affordable care act and long-term care: comprehensive reform or just tinkering around the edges?

The Patient Protection and Affordable Care Act (ACA) includes several provisions that aim to improve prevailing deficiencies in the nation's long-term care system. But just how effective is the ACA likely to be in addressing these challenges? Will it result in meaningful or marginal reform? This special issue of Journal of Aging & Social Policy seeks to answer these questions. The most prominent long-term care provision is the now-suspended Community Living Assistance Services and Supports Act. Others include incentives and options for expanding home- and community-based care, a number of research and demonstration projects in the areas of chronic care coordination and the dually eligible, and nursing home quality reforms. There are also elements that seek to improve workforce recruitment and retention, in addition to benefit improvements and spending reductions under Medicare. This article reviews the basic problems plaguing the long-term care sector and the provisions within the ACA meant to address them. It also includes a brief overview of issue content.     

Neighbourhood social ties: how much do residential,physical and virtual mobility matter?

Following up on the prediction by classical sociological theorists that neighbours will become irrelevant as societies become more mobile, this research examines the strength of people's social ties with neighbours and the associations thereof with residential, physical and virtual mobility using longitudinal data for Germany. Unlike previous studies, the research considers the three forms of mobility simultaneously and contrasts its effects on social ties with neighbours to those with family. The results show that residential and physical mobility are negatively associated with social ties to neighbours and positively with ties to family. Virtual mobility does not weaken social ties with neighbours but ties with family. The positive association between mobility and social ties with family may not be strong enough to ascertain that people maintain as close social ties to others in the future as it does not outweigh the negative association with visiting neighbours.     

Are baby boomers who care for their older parents planning for their own future long-term care needs?

A rapidly expanding number of baby boomers provide care to aging parents. This study examines associations between caregiver status and outcomes related to awareness and anticipation of future long-term care (LTC) needs using 2007 Connecticut Long-Term Care Needs Assessment survey data. Baby boomers who were adult child caregivers (n = 353) versus baby boomers who were not (n = 1242) were more likely to anticipate some future LTC needs and to have considered certain financing strategies. Although baby boomer adult child caregivers more readily anticipate some future LTC needs, they are not taking specific actions. It is important to address the need for public education directed toward those who are currently (or have recently completed) caring for aging parents.