Frailty in self-neglecting older adults: A secondary analysis

ABSTRACT

Self-neglect (SN) and frailty in older adults is associated with increased disability and mortality. Despite these commonalities, there have been no studies objectively assessing frailty in older adults who SN. This secondary analysis classified frailty in N = 37 older adults with Adult Protective Services validated SN using the Fried Frailty Phenotype (FFP) of weight loss, weakness, exhaustion, activity level, and walking speed. Overall, 3% were classified as robust, 62% as prefrail, and 35% as frail. Most (72%) were overweight/obese, with clinically significant decreases in activity level (60%) and walking speed (97%). Compared to the original FFP population, older adults who SN exhibit important differences in frailty phenotypes, and finding that the largest percentage of older adults who SN were prefrail may indicate a critical opportunity for intervening in this population to reduce future functional decline and mortality.     

Mobility,migration and rights in the European Union: critical reflections on policy and practice

This article assesses developments in European Union (EU) migration policy and practice and their implications for rights regulation in the Union, as revealed in this special issue and the wider literature. It identifies how rights are constituted in the complex and multivalent policy-making field of the EU. The article views rights as constituted in the process of migration governance. This governance analysis puts centre stage an assessment of the links between policy, policy-making and policy's social and political ordering effects. The article argues that the significance of the Union needs to be analysed against different aspects of rights regulation. The article adopts an analytical framework which discriminates between the discursive framing of migrants' rights, the specification of such rights in Union and member state policy, and the shaping of rights by actors in context at the local level. The article concludes that, first, the Union has begun to play a significant role in regulating mobility rights across its territory in ways which can undermine the substantive or normative rights accessible to migrants in practice. Second, its policy and legal role are politically significant as it asserts the role of the EU as a source of regulatory authority over the distribution of rights for citizens and non-citizens within its territory.     

Psychological Distress Experienced by Parents of Young Children With Congenital Heart Defects: A Comprehensive Review of Literature

ABSTRACT

The purpose of this study was to examine the existing research on the psychological distress experienced by parents whose young children (between the ages of 0 and 5 years old) have a congenital heart defect (CHD). A more detailed understanding of the distress experienced by these parents, including stress associated with the child's age, the severity of the child's diagnosis, and parent characteristics, is vital as it would allow for more targeted and individualized support for this population to enhance parental coping strategies and increase the likelihood of more positive parent–child interactions. This review of 25 studies contributes to the parenting stress literature by focusing on parents of young children and categorizing studies by publication characteristics, research methodology, and findings. The research clearly demonstrates that parents report a great deal of stress throughout the continuum of their child's health care experience. Recommendations for future research and practice implications, such as developing a stress vulnerability model specific to parenting children with CHD, clarifying the role between interdisciplinary team members regarding provision of psychosocial support to parents, and referring parents to specific community-based ongoing social support services, are presented.     

Exploring the Therapeutic Relationship A Case Study

This paper is focused on the topic of the therapeutic relationship in systemic therapy. It is structured around the discussion of my experience of work with a particular family where the engagement issues were complex, and where there was the potential for a negative therapy sequence. The psychoanalytic concepts of transference, countertransference and projective identification are chosen to discuss my dilemmas — however, the differences between the analytic and systemic contexts of work are noted. Through the discussion of this case study, the potential benefits of using these analytic ideas to understand the therapeutic relationship in specific situations in systemic therapy are identified.     

Construction of Peer Support Groups in Child Protection Social Work: Negotiating Practicalities to Enhance the Professional Self

This paper reports on a research project that was developed between a cohort of child protection social workers in the Republic of Ireland and the authors. The focus of the research was on researching participants’ experiences of developing peer support groups (PSGs) in child protection social work. Eleven participants formed two PSGs; one group had six participants, the other had five. This qualitative research study involved focus groups with each of the peer groups at the beginning, middle and end of the 12-month period. Data from the focus groups were analysed using thematic analysis (Braun & Clarke, 2006). Findings from the research indicate that the organic development of a PSG involves negotiating a range of practicalities which, working together, help to promote reflective practice and to advance the development of the professional self. A number of important and interconnected subthemes emerged within the texts of the focus groups. These included: the establishment of PSGs as a work activity; consideration of logistical matters in forming PSGs; identification of the influence of group dynamics in structuring and negotiating PSGs; PSGs as a conduit for integrating personal and professional values and as a context for facilitating and enabling an increased consciousness of self in practice. Drawing on these findings, the authors consider the implications for integrating PSGs within child protection agency services.     

Limits and Possibilities of the Postmodern Narrative Self

The task of theorising the self has been of little interest historically in systemic therapy, yet becomes more interesting in the postmodern turn to the narrative metaphor and social constructionist ideas. Within this frame, the self is theorised as relational, fluid, and existing in narrative. The ‘postmodern narrative self’ counters modernist assumptions of self as an autonomous and fixed ‘internal’ entity, and brings with it theory and practice possibilities. However, any theory also brings limits, and this paper explores the limits of the central ideas of the postmodern narrative self. Through questioning and discussion, an argument is made for holding a dialectic in our thinking about the relational and autonomous self, for acknow-ledging very real boundaries on the fluidity of self, and for thinking of narrative as one way of knowing self, rather than exclusively constituting the ‘being’ of self.     

The Effectiveness of Different Representations for Managerial Problem Solving: Comparing Tables and Maps

Geographic Information Systems (GIS) enable decision makers to view tabular data geographically, as maps. This simple yet powerful visual format appears to facilitate problem solving, yet how it does so is not clear, nor do we know the types of problems that benefit from this representation. To begin to understand the contributions of geographic representations over tabular representations, we conducted a three-factor experiment in problem solving. The experiment contained two different representations (map and table), three different geographic relationships (proximity, adjacency, and containment), and three levels of task difficulty (low, medium, and high). We found that maps generally produced faster problem solving than tables, and that problem-solving time increased with task difficulty. Most importantly, for the proximity and adjacency geographic relationships we found that maps kept problem-solving time low, while tables tended to increase time dramatically. However, we found that the number of knowledge states for each task explains performance times quite well and is a useful tool for understanding performance differences and interaction effects. As tasks become more difficult, representing them as maps generally keeps the number of knowledge states small, while for tables, the number of knowledge states increases dramatically. Correspondingly, problem-solving times increase dramatically with tables, but not with maps. In sum, as difficulty increases, maps are more effective for problem-solving tasks. Using maps, the tasks are simplified using visual heuristics that keep problemsolving times and error rates from rising as quickly as they do with tables.     

Realizing the potential of a strengths-based approach in family support with young people and their parents

This paper on a strengths-based approach (SBA) to practice is based on empirical research with stakeholders involved in an intensive support programme for young people at risk and their parents in Ireland. The Youth Advocate Programme (YAP) model provides wraparound support to respond to their needs by focusing on their competencies and their coping skills and building networks of community-based supports. The model includes parents or carers in the suite of support offered by advocates. An SBA to practice has been discussed for some time in academic literature and practice guidance. However, it tends to be considered primarily in relation to social work practice, and there is ongoing ambiguity as to what it actually involves in day-to-day engagement with individual family members. Insightful, rich accounts of SBAs as part of routine practice provided by young people, parents and practitioners form the basis to this paper and detail how these approaches support the development of hope-inspiring relationships and promote positive change. Relevant literature and research situates the debate on the experience of using SBA, the wider challenges faced by families, the impact of SBA in practice on those receiving the support service and its potential for use in the wider continuum of children and family services.     

Protective support and supportive protection for families “in the middle”: Learning from the Irish context

This paper critically examines the relationship between statutory family support and child protection using the case study of Ireland. It builds on the work of Devaney and McGregor (2017) to offer an additional contribution to existing frameworks for practice through adapting the Hardiker Exton and Barker (1991) model of prevention. Using evidence from current Irish developments, the case for moving away from linear and simplistic differentiation of family support and child protection is made. Evidence from three main sources in Ireland is presented to develop the argument. This evidence includes the Child Care Law Reporting project (Coulter, 2015, 2018); a recent evaluation of a family support practice model called Meitheal (Rodriguez Cassidy and Devaney, 2018) and recent findings about public awareness of family support (McGregor and NicGabhainn, 2018). We argue that special attention should be paid to families “in the middle” who are in need of both support and protection and propose an adapted version of Hardiker et al. model to aid in this work. We identify what should happen at different levels for macrostructural to micropractice levels. We conclude that the learning from the Irish case study can be applied to an international context.