Complex home care: challenges arising from the blurring of boundaries between family and professional care

Over the last 50 years, increasingly complex care (such as tracheostomy management, dialysis or enteral feeding) has shifted from hospital to home, with a concomitant rise in patient self-management and care given by family members. Recognition of the importance of the contribution of family care to the health system is also growing. This article reports the findings of a New Zealand study which explored the experiences of family carers who manage technical health procedures at home. It then draws attention to some broader issues raised by shifting complex care from professional management in hospital settings to family care at home, namely the ways in which complex home care blurs the boundaries between professional and family care (creating the ambiguous position of the expert carer) and questions of safety and responsibility in family care. We also discuss the implications for policy around family caregiving in New Zealand. Given the potential physical and mental health impacts of caring, it is time for renewed consideration of what family carers should be expected or allowed to manage and how the health system can support them in their important role.     

The Relation of Negative Career Thoughts to Depression and Hopelessness

Although some research literature focuses on the integration of mental health and career counseling, there has been little that examines both areas in relation to depression and hopelessness. This study investigated the relationship among dysfunctional career thinking, depression, and hopelessness in a sample of 139 undergraduate and graduate students seeking drop‐in or individual career counseling services at a university career center. The authors found that two aspects of dysfunctional career thinking, decision‐making confusion and commitment anxiety, accounted for a significant amount of variance in depression. Decision‐making confusion also accounted for a significant amount of variance in hopelessness. Implications for counseling practice include the need for more careful screening of career clients who present with high levels of anxiety and negative thinking. Future research could involve more diverse client populations, such as unemployed adults, and explore the use of additional screening measures to assess the intersection of career and mental health issues.     

Short Break and Respite Services for Disabled Children in England: Comparing Children's and Parents' Perspectives of Their Impact on Children

Researchers, health and social care workers often seek to understand the perspectives of children; but gathering views directly from children can present difficulties. Parents are often asked to provide accounts of children's feelings or opinions on the assumption that their proxy reports are accurate and unproblematic. This qualitative thematic analysis of open‐question responses from 352 parents and 73 disabled children examines their accounts of the impact of short break services on disabled children. Participants' perspectives differed; children tended to describe immediate outcomes such as enjoying activities and participation; parents acknowledged these, but focused on longer term developmental outcomes for children.     

Inferences About Sexual Orientation: The Roles of Stereotypes,Faces, and The Gaydar Myth

In the present work, we investigated the pop cultural idea that people have a sixth sense, called “gaydar,” to detect who is gay. We propose that “gaydar” is an alternate label for using stereotypes to infer orientation (e.g., inferring that fashionable men are gay). Another account, however, argues that people possess a facial perception process that enables them to identify sexual orientation from facial structure. We report five experiments testing these accounts. Participants made gay-or-straight judgments about fictional targets that were constructed using experimentally manipulated stereotypic cues and real gay/straight people's face cues. These studies revealed that orientation is not visible from the face—purportedly “face-based” gaydar arises from a third-variable confound. People do, however, readily infer orientation from stereotypic attributes (e.g., fashion, career). Furthermore, the folk concept of gaydar serves as a legitimizing myth: Compared to a control group, people stereotyped more often when led to believe in gaydar, whereas people stereotyped less when told gaydar is an alternate label for stereotyping. Discussion focuses on the implications of the gaydar myth and why, contrary to some prior claims, stereotyping is highly unlikely to result in accurate judgments about orientation.     

Comparing Social Work Students’ Perceptions of Risk Using Online Discussion Fora: Lessons Learned from a European Pilot Project

Comparisons of international child welfare systems have identified two basic orientations to practice; a ‘child protection’ orientation and a ‘child welfare’ orientation, which are founded upon fundamentally different values and assumptions regarding the family, the origins of childcare problems, and the proper role of the state in relation to the family. This paper describes a project which sought to compare how undergraduate social work students from three European Universities perceive risk in referrals about the welfare of children and to explore the impact of different cultural, ideological and educational contexts on the way in which risk is constructed by students. Students from Northern Ireland, Germany and Poland examined three vignettes via 10 online discussion fora each of which provided a narrative summary of their discussion. The paper presents some findings from the analysis of the qualitative data emerging from the student discussions and draws out the lessons learned in terms of how the project was designed and implemented using online discussion fora.     

International adoption and the formation of new family attachments

Clinical studies of children in international adoption reveal unique patterns of psychological adjustment to permanent family care. Pre‐adoption history often includes early object loss, medical and nutritional deprivation, multiple care‐giving disruptions, and the lack of primary care‐giving relationships. These factors and the age at the time of adoption are risks to positive emotional and cognitive development. Adoptive parents may be unprepared for the resulting developmental problems. Most significantly, parents and children are often at different points in readiness to establish an attachment relationship. The parents are eager to claim their child, but the child is unready to respond because of emotional fragility and lack of previous attachment experiences. Two clinical vignettes illustrate the importance of a developmental and medical framework in assessing the unique needs of these survivor children, as well as the necessity of an empathic therapeutic holding environment that can sustain the emerging family attachments under stress. The psychological impact of cross‐cultural adoption and traumatic early beginnings reverberates across time but with empathic parental care and treatment recovery can be significant.     

Expanding the Role of Long-Term Care Social Workers: Assessment and Intervention Related to Urinary Incontinence

Urinary incontinence (UI) is a common and stigmatizing problem faced by long-term care (LTC) residents. It is typically addressed by medical professionals, with social work rarely involved. The purpose of this article is to illustrate how social workers can address the psychosocial implications of UI while working with residents and their family members as part of an interdisciplinary team. Using a case example and the NASW objectives for LTC, recommendations on how the role of the LTC social workers can be expanded to better address both the needs of residents, families, and the larger LTC system are provided.     

Help, Not Harm: Psychological Foundation for a Nondieting Approach Toward Health

This article reviews the literature on the psychological consequences of dieting. In particular, the authors examine the impact of dieting on mood, self-esteem, cognition, and eating behavior. The famous Keys study of starvation is discussed in relations to impaired concentration, food preoccupation, negative affect, and binge eating behavior. Overall, the literature indicates that dieting has a negative impact on psychological well-being. As a result, alternative nondieting approaches toward eating are presented and recommended to promote psychological health.     

What you say,and how you say it: Preschoolers' growth in vocabulary and communication skills differentially predict kindergarten academic achievement and self‐regulation

The idea that language skills support school readiness, predicting later self‐regulation and academic success, is widely accepted. Although vocabulary is often emphasized in the developmental literature, the ability to use language appropriately in the classroom, or social communication skills, may also be critical. This article examined longitudinal contributions of children's vocabulary and social communication skills, from preschool to kindergarten, to kindergarten academic achievement (reading and math) and self‐regulation (executive functions and learning behaviors). Participants were 164 children (14% Latinx, 30% Black, 56% White; 57% girls) enrolled in Head Start programs. Results revealed that initial levels and growth in vocabulary and communication skills predicted better academic achievement. Social communication skills uniquely predicted self‐regulation, after accounting for vocabulary. We discuss potential mechanisms for these links and recommend that strategies to build social communication skills be incorporated in preschool interventions promoting school readiness.