Adult Day Centers and Mental Health Care

ABSTRACT

This research focused on the mental health issues at adult day centers and used a cluster analysis to profile older persons who received these services. The sample included 280 participants who attended adult day care. The data were collected from intake files using a biopsychosocial framework to guide the selection of variables from January 1, 1999 to December 31, 2000. A cluster analysis revealed two distinct profiles of participants. The first profile was characterized by women, who were single, African-American, had low incomes, relied more on public funding, and had no psychiatric diagnoses. The second profile was differentiated with more men, who were married, relied more on private funding, and had higher incomes and psychiatric diagnoses. Participants clustered in the second profile, including those diagnosed with psychiatric disorders, disenrolled at a faster rate than those in the first profile, including older adults without psychiatric disorders. Both profiles were similar in age, education, caregiving, religious affiliation, household size, and service intensity. They also resembled each other with respect to functional limitations, nutrition risk, and prior nursing home placement. Slight differences were found in frequency of previous hospitalizations and years of education. Recommendations for strengthening the mental health training of social workers employed at adult day centers were made.     

Where Do We Stand? Testing the Foundation of a Shared Site Intergenerational Program

Abstract

Shared site intergenerational care programs provide ongoing services simultaneously to old and young community members at a single facility, thereby, meeting the care needs of multiple generations. However, they face the challenge of sustainability common to all community-based programs. We employed the results management model to identify program elements that may enhance or inhibit sustainability of intergenerational programming at a shared site facility involving a child development lab school and adult day services program. The 4-step results management approach is a strengths-based model that supports community capacity and achievement of community and program goals. The current paper describes the first step in the results management approach, mapping the terrain, which involves gathering evidence of community needs and strengths. Focus groups were conducted with eleven staff members from both programs after a 4-month intergenerational program. The focus groups targeted the needs and strengths related to intergenerational programming. Respondents identified strengths that enhanced staff members' and clients' capacity for collaboration. These included affective and developmental benefits for both generations and strong partnerships between staff members. Respondents also identified factors that limited collaboration, such as the need for greater authority support and cross-training opportunities. Findings from our study have been used by program administrators to continue using the results management approach to further build intergenerational community and expand the scope of evaluating intergenerational shared site programs. Other intergenerational programs may utilize the results management model to enhance intergenerational programming and increase program sustainability.     

An Examination of the Adult Day Services Industry Using the Resource Dependence Model within a Values Context

The adult day services (ADS) industry continues to grow and develop in providing care to larger numbers of older adults and their caregivers. Despite the growth in the number of programs and the changes in the way services are delivered, a systematic examination of the development of the ADS industry from a policy perspective has not been published since the mid-1990s. This article provides an analysis of the development of the ADS industry using the resource dependence model within a values-based context to determine whether public reimbursement opportunities are congruent with the needs of older adults and caregivers. Potential directions for the future development of the industry are presented through analysis of the collaborations of adult day providers with the providers of other services for older adults and the effort by public and private funders to connect quality outcomes and resources.     

The effectiveness of adult day services for disabled older people

Adult day care has attracted a considerable amount of attention among researchers, practitioners, and policymakers. However, there have been few efforts to synthesize empirical results. This paper reviews research that determines the effectiveness of adult day services in improving client functioning, alleviating caregiver stress, and delaying nursing home placement. In addition, the strengths and limitations of the research are considered. This paper concludes with a discussion of policy-relevant issues that must be addressed when determining the effectiveness of adult day services.     

Partial Hospitalization Treatment for Clinical Depression

Abstract

This article describes an outcome study evaluating the effectiveness of a partial hospitalization program (PHP) on the treatment of clinically depressed clients. Within the context of a relatively non-intrusive one-group pretest-posttest research design, nine adult clients completed the Generalized Contentment Scale (a measure of non-psychotic depression) at admission to, and discharge from, the PHP. The clients experienced statistically significant and clinically meaningful improvements between admission and discharge from the PHP. This MSW student-conducted program evaluation represents the type of easy-to-conduct outcome studies which are increasingly being called for in today's practice environment.     

Testing Faith

Abstract

The U.S. federal government, through Charitable Choice, has opened public funding for the delivery of social services to faith-based organizations (FBOs) more than ever before. This increased access to governmental funding at all levels has led to a closer examination of the evidence base on the effectiveness of the services provided by FBOs, and the capacity of FBOs to respond to data needs for accountability and program improvement efforts. This paper discusses the current status of evaluation research on FBO services and the emerging data needs among faith-based providers. Promising avenues for enhancing the current understanding of outcomes of FBO services are explored such as (1) adopting outcome measurement practices in use within the current nonprofit sector, and (2) developing more rigorous research designs tailored to the special contexts of faith-based services. The paper suggests an agenda in which FBO operators, funders, and evaluators work together to move forward in improving the evidence base on faith-based services.     

Organization and Delivery of Long-Term Care in Taiwan

Summary

Taiwan reached the World Health Organization (WHO) benchmark of7%aged 65and over for defining an aging population only as recently as 1993. With this proportion projected to double to 14% by 2020, Taiwan faces a rapid increase in need for long-term care. This article presents an account of the current service delivery system, which is divided between health and social affairs administrations, with a substantial role also taken by the Veteran Administration, and growing provision of facilities that operate outside the government-registered system. While a basic level of both institutional and community care services has developed, they are not organized into an integrated service system. Problems arising from the divisions and overlaps in responsibility are identified in relation to competition for resources, differences in regulation and eligibility, funding arrangements and misallocation of resources, and divergent views about the philosophical basis of long-term care. Other aspects of services fall under each jurisdiction, but there is also some overlap. A case study of Taiwan's second largest city, Kaohsiung City, reports the outcomes of these divisions as a thin spread of a range of services rather than a coordinated service network. Several planning exercises have been undertaken in recent years to address these problems, and although at an early stage of implementation, the outcomes of these plans are seen as shaping the future directions of long-term care in Taiwan.     

The Impact of Automation on Attitudes and Productivity in a Human Services Agency

Summary

This paper presents the results of a research project designed to assess the impact of an automated case management system on the time utilization and attitudes of human services employees. Based on this 10 week evaluation study, the desired benefits in efficiency, effectiveness and quality of work life were not achieved. Limitations of this study were the constraints in the length of time the evaluation could be conducted and the small sample size available. The findings of this research highlight the need for employee assistance program managers to be sensitive to and knowledgeable about the potential sources of stress as well as the potential benefits in introducing computer technology into the human services delivery system.     

Perceptions of Adult Protective Services Workers of the Support Provided by Criminal Justice Professionals in a Case of Elder Abuse

ABSTRACT

This paper summarizes results of a 1997 survey of adult protective services workers in 43 states. The survey yielded ratings of police and victim assistants in detecting and treating elder abuse and estimates of the likelihood that criminal justice professionals would provide ten forms of assistance in a case of elder abuse. Respondents also reported the most helpful services supplied by criminal justice professionals, the services that were most difficult to obtain, and overall ratings of criminal justice professionals in cases of elder abuse. Findings provide insights about relationships between adult protective services workers and criminal justice professionals.     

Long-Term Care Funding in Canada

Summary

When Canada was founded, health care was delegated as a provincial responsibility. Although the federal government shares a portion of health care costs, it is not directly responsible for the planning, delivery, and governance of health services. The 1984 Canada Health Act set national standards for the provision of physician and hospital services, but it does not apply to home care and long-term care facilities. Consequently, each province has established a unique approach to long-term care, resulting in a health policy mosaic. This paper examines different approaches to funding long-term care with a particular emphasis on the impacts of regionalization and of the implementation of case-mix-based funding systems.     

Kaiser Permanente's Manifesto 2005 Demonstration

Summary

In 1996, the eight-million member Kaiser Permanente HMO adopted a vision statement that said by 2005 it would expand its services to include home- and community-based services for its members with disabilities. It funded a 3-year, 32-site demonstration that showed that it was feasible to link HMO services with existing home-and community-based (HCB) services and that members appreciated the improved coordination and access. This private-sector project showed that devolution can produce innovative and feasible models of care, but it also showed that without federal financial and regulatory support, such models are unlikely to take hold if they are focused on “unprofitable” populations, for example, those who are chronically ill, poor, and/or disabled.     

It Kind of Made Me Feel Important

Abstract

The enactment of the Personal Responsibility Work Opportunity and Reconciliation Act (PRWORA) in 1996 led to sweeping changes in U.S. welfare policy and practice. Given the time limits placed on adult recipients of cash assistance, and the multiple barriers to employment that many of these recipients face, alternative intervention strategies need to be developed. Welfare-to-work interventions provided by faith-based groups are one such intervention strategy. This paper discusses the rationale for faith-based services and introduces research conducted on one particular faith-based model of intervention for the target population. Findings presented center on participants' perceptions of the faith-based services they received, particularly on aspects of the program that were helpful and meaningful to them.     

Assessing the Effectiveness of Faith-Based Programs

Abstract

The policy debate over faidibased initiatives has prompted calls for comparative effectiveness research. Drawing examples from an evaluation of California's Community and Faith-based Initiative (CFBI), we illustrate a research strategy that takes local networks as the primary unit of analysis. This approach focuses on understanding the roles different organizations play within local service delivery networks, and on analyzing how local actors coordinate services to affect participant, organization, and system outcomes. The network perspective casts new light on policy options, and suggests that caution is necessary when using administrative data to interpret program effectiveness.     

Bibliography

Summary

Advocates for the application of computer technology in the human services assume that it promotes practice and organizational effectiveness as well as efficiency. Opponents claim that it fragments practice and reinforces the worst, most punitive, and counter-productive aspects of bureaucracy. While each of these positions rests on conflicting theoretical assumptions about the nature of practice, organizational structures, professionalization and information technology, proponents and opponents alike have failed to provide evidence to support their positions or even to recognize that these issues can be framed and tested empirically.

This paper proposes the use of a comparative research design for studying the effect or computerization on program effectiveness and outlines a range of variables which need to be taken into account in addressing the differential impact of computerization on social work practice.     

Evolve Therapeutic Services: A 5-year outcome study of children and young people in out-of-home care with complex and extreme behavioural and mental health problems

BackgroundLittle evaluation research has been conducted on the effectiveness of services and intervention provided to children in out-of-home care. This study evaluated an innovative Queensland, Australia program employing a collaborative wrap-round model of care in combination with a flexible intervention approach, individually tailored to children and young people in out-of-home care presenting with complex and extreme behavioural and mental health problems.MethodThe sample consisted of 664 children and young people. Two clinician-rated measures, the CGAS and HoNOSCA, were used to assess young people's functioning via a pre-post-treatment design.ResultsResults revealed significant improvements across a range of problems areas: general functioning and adjustment; disruptive, antisocial and aggressive behaviour; overactivity, poor attention and concentration; non-accidental self-injury; problems with scholastic and language skills; non-organic somatic symptoms; emotional symptoms; peer and family relationships; self-care and independence; and school attendance.ConclusionFindings provide good evidence for the effectiveness of the therapeutic intervention program. Implications for future research are explored.     

Setting the Context

Abstract

This paper provides an overview of assessing the effectiveness of newly legislated social policies. In an era of growing public reliance on faith-based social services, it is imperative to be accountable and assess the efficacy and effectiveness of this set of providers. It discusses the paucity of such attempts and the complications involved in measuring effectiveness of social programs, especially when religion is involved. It then reviews the contributions provided in this volume and draws conclusions for future Studies.     

Houston Homeless Street Outreach

Abstract

Several cities in the nation have developed innovative programs to assist the homeless who are “living on their streets.” This paper describes one such program developed in Houston, Texas. The Homeless Street Outreach was a collaborative project of several service agencies in the greater Houston area. The outcome of this outreach project indicates that a coordinated effort can bring about delivery of more comprehensive services to the homeless population. The principles that emerge from the outreach include involvement of the homeless in planning and development, service agencies taking “ownership” of the project, and agency flexibility in delivering services to the homeless.