Prevention of Elder Mistreatment in Nursing Homes: Competencies for Direct-Care Staff

Existing training on elder mistreatment in nursing homes focuses on detection and reporting of abuse, with little training specifically targeted toward prevention of mistreatment before it occurs. We used qualitative interviews with nursing home staff, policy makers, and related professionals to identify training needs. Based on participant accounts, we drafted a number of competencies essential for caregiver training to prevent mistreatment in nursing homes. Competencies include those dealing with definitions and policies, risks for mistreatment, communication and respect in relationships with residents, and development of a cooperative work environment. Competencies are discussed along with illustrative examples, and implications for practice and policy are addressed.     

Maternal substance abuse and disrupted parenting: Distinguishing mothers who keep their children from those who do not

Women with substance abuse disorders typically have psychosocial characteristics that put them at risk for disrupted parenting. Prior research indicates that comprehensive, accessible services tailored to the mothers' needs can contribute to family stability. This study further explores the complicated interplay of how maternal risk and protective characteristics and service elements are associated with reunification. The study contributes to existing literature by following mothers for three years; examining service needs as identified by the mother herself; using a summary proportion score to reflect the totality of services received to matched service needs identified; and using logistic regression to examine interactions of services received with critical maternal characteristics. The sample is comprised of 458 substance-abusing mothers enrolled during pregnancy or postpartum in the Washington State Parent-Child Assistance Program (PCAP), an evidence-based case management intervention. Participants' custody status was well distributed among four categories based on continuity of parenting. Findings indicate that at program exit 60% of the mothers were caring for their index child. These mothers had more treatment and mental health service needs met, had more time abstinent from alcohol and drugs, secure housing, higher income, and support for staying clean and sober. Among women with multiple psychiatric diagnoses, the odds of regaining custody were increased when they completed substance abuse treatment and also had a supportive partner. Mothers who lost and did not regain custody had more serious psychiatric problems and had fewer service needs met. We discuss implications of our findings for child welfare policy and practices.     

Work disability and migration in the early years of welfare reform

The inter- and intra-state migration of American families with work-disabled members is a neglected area of empirical study. Longitudinal migration and health status data from the 1996 Panel of the Survey of Income and Program Participation (SIPP) are merged with state-level welfare policy indicators to investigate migration behavior under welfare reform’s emphasis on requiring work and encouraging reliance on social support networks. We use a nested discrete-choice event history model that incorporates the departure decision and interstate destination choice in a single model that tests the effects of state-level welfare policy and economic opportunity characteristics, with state fixed effects, plus family sociodemographic characteristics and social networks, as the basis for comparing migration of families with and without work disabilities. The results show that although families with disabilities and illnesses are less likely to migrate than other families generally, they are “pushed” to migrate if they live in states that do not exempt them from TANF activities requirements. Furthermore, in-migration is inhibited by stringent state welfare illness exemption rules and high state unemployment rates. Intrastate migration is more likely among families who received family and community social support, regardless of work-disability status.