Quality care for ill children: AIDS-specialized foster family homes

Children with AIDS and related complexes present a new and serious challenge to the child welfare field's foster care system. At this stage of the world's knowledge of AIDS and treatment capacity for its victims, the children are stigmatized as plague bearers, their viability is unknown, and few, if any, will ever have a home to return to. This article describes a special foster care demonstration in behalf of AIDS infants.     

The need for policy direction in the provision of care to the mentally ill: an interdisciplinary view

This paper argues that mental health care is underprovided, and that the role of nonprofit providers should be expanded for three major reasons. First, a positive externality exists since society, as a whole, benefits when those in need of mental health care consume care. External benefits include lower crime rates, lower unemployment, and less homelessness. Second, consumers of mental health care are mentally ill and often do not believe that they need care, underestimate their need, or believe that care is not worth the time or expense. Third, common law, to a large extent, is based on individual liberty, largely ignoring the benefits individuals receive from treatment. It is argued that government policy is needed to increase the supply of mental health care, through nonprofit agencies.     

The meaning of family-like care among operators of small board and care homes

Thirty-six operators of small board and care homes were interviewed to explore how they conceptualize the care that they provide to frail, elderly persons. The meanings these operators attach to the care they provide reveal, through stories of “why” and “how” they provide care, both shared meanings and dimensions of difference in how they view their work. A range of motivations (the “why” of care), from altruism to economics, combine with varied styles of service delivery (the “how” of care), from full domestic integration to separate domains, to create a typology of meanings in this form of residential care. Implications of these dimensions for quality of care and social policy are derived from this typology.     

The impact of ideology on regulation: The case of board and care homes

Debates about regulatory efforts to monitor the delivery of health and long-term care have become commonplace in health policy. Efforts to examine the key assumptions underlying the current regulatory strategies have been limited, however. Using the board and care industry as an example, this article examines how ideology influences the regulatory strategy developed. Three ideological perspectives-a free-market approach, a market correction strategy, and a critical policy framework-are reviewed in the context of efforts to regulate board and care homes in the United States. Differences in approaches to regulating board and care are presented for each of the major perspectives.     

Family to family: reconstructing foster care in the US

The public child welfare system in North America is faced with growing deprivation, rising numbers of children who need out-of-home placements for increasingly lengthy periods, and a shortage of foster carers. The Family to Family initiative offers public agencies funds and tools to help them strengthen family support services within the communities from which children enter the system, improve the quantity and quality of neighbourhood-based foster carers and develop the capacity to collect and analyse outcome data.     

The evaluation of case management services with the chronically mentally ill

This study reports the results of an experiment comparing a developmental-acquisition model of case management to usual case management services provided through a mental health center. This is the first study of case management with the chronically mentally ill to employ a true experimental design comparing two types of case management service. The statistically significant discriminant functions resulting from the analysis correctly classified 77% of the subjects based on the case manager's assessment of clients' socialization skills, assessment of community living skills by a significant other and the client, the client's tolerance of stress, use of leisure time, community behavior, and vocational training. Implications for research and service delivery are discussed.     

Labeling theory and community care of the mentally ill in California: the relationship of social theory and ideology to public policy

The practical merit of a labeling theory approach to mental illness is examined and assessed through an exploration of its application in terms of public policy, i.e., community mental health policy in the state of California since 1968. Primary focus is placed on the impact of the deinstitutionalization of mental health services in that state, and the release of former mental patients into the community. Similarities in the fundamental ideological underpinnings of labeling theory, an associated conspiratorial model of mental illness, and contemporary California mental health policy, are presented and examples of policy input by labeling theorists and researchers are detailed. The impact of the California policy on the mentally ill is generally negatively assessed in terms of three major criteria: (1) rehabilitation; (2) reintegration; and (3) quality and continuity of care. The "translation" of several theoretical misconceptions regarding mental illness, caused by putting labeling theory into official policy, is suggested to lie at the root of many of the policy's implementation problems. The uses of social science theory and research are discussed, and caution is advised in the translation and application of social scientific theory and research to public policy proposals and programs.     

Memory and meaning in the psychotherapy of the long-term mentally ill

After a long period when the treatment of major mental illness was under the decisive influence of the biological revolution in psychiatry, there are now growing signs of a revival of the role of psychotherapy in understanding the lived experience of psychotic disorders. Despite increased attention to the subjective world of persons afflicted with severe mental illness, considerably less has been written about the devastating effects of a loss of reality on memory and meaning and about the especially complex ordeals facing therapists who enter into long-term relationships with clients cut off from the past and the future. The ensuing quest for meaning amid the breakdown of memory is the focus of this paper.     

Enhancing parent-child interaction during foster care visits: experimental assessment of an intervention

Mothers of young children recently placed in foster care participated in an intervention to enhance parent-child interaction during visits. The mothers all reported substantial loss and trauma histories. Immediately prior to the visits, the mothers were coached on strategies for separating from their children at the visit's end. The mothers displayed more behavioral strategies for supporting their children when the visit was over, but were less engaged with their children during the leave-taking sequence and displayed fewer ways of maintaining the child's involvement in mother-child interaction during leave-taking than those in a comparison group. This article discusses consideration of parents' trauma history in designing interventions to enhance parent-child interaction.     

The career of the mentally ill: an integration of psychiatric, labeling/social construction, and lay perspectives

This paper provides a new way of conceptualizing the career of the mentally ill. Most persons who experience an episode of a serious mental disturbance lead a normal life, while a few persons lead lifetimes that revolve around their mental disorders. The processes leading to either result can only be understood by integrating the traditional labeling and psychiatric perspectives with lay understandings of the concepts of "mental illness" and "nervous breakdowns." A selection of key concepts from these perspectives leads to a better understanding of the different paths persons take as they move through the pre-patient, inpatient, and post-patient phases of the "career of the mentally ill." This perspective makes understandable a number of counterintuitive relationships. For example, it explains why most hospitalized mental patients (1) have a negative stereotype of the "mentally ill," (2) do not perceive themselves as "mentally ill, yet (3) perceive themselves as benefiting from treatment, and (4) do not progress into a career of secondary deviance.