Factors that Influence Physical Activity among Residents in Assisted Living

ABSTRACT

The purpose of this study was to examine factors that influence physical activity among residents in assisted living. This was a secondary data analysis using baseline data from a function-focused care intervention study including 171 residents from 4 assisted living facilities. Using structural equation modeling, we found that mood, satisfaction with staff and activities, and social support for exercise were directly associated with time spent in physical activity. Gender, cognition, depression, and comorbidities were indirectly associated with physical activity and accounted for 13% of the total variance in physical activity. Implications for future research and social work practice are presented.     

Helping foster youth find a job: a random‐assignment evaluation of an employment assistance programme for emancipating youth

A primary task for youth aging out of foster care is finding and maintaining a job. In recognition of the challenges that foster youth face, employment assistance has become an important part of child welfare agencies' efforts to prepare youth for emancipation. The current study uses random assignment to evaluate the impact of an employment assistance programme for foster youth on the rate of employment, income and other self‐sufficiency outcomes among a group of adolescents in substitute care in Kern County, California. Data were collected via multi‐wave, in‐person interviews of 254 foster youth. At the second follow‐up interview, only two‐fifths of the sample report being employed. However, three‐quarters of the sample are either working or attending school, and a quarter reports both working and attending school. Nevertheless, significant minorities report experiencing financial hardships and receiving financial assistance. No statistically significant impacts of the evaluated programme are found on any measured employment or self‐sufficiency outcome. Implications for child welfare policy are discussed.     

The impact of parental incarceration on children's care: identifying good practice principles from the perspective of imprisoned primary carer parents

Parental incarceration has wide‐ranging impacts on families. One key effect may be disruption to the care and legal custody of children, yet few studies have examined processes and outcomes relating to care planning for children of prisoners. This paper presents findings of interviews with 151 primary carer prisoners in two Australian states which aimed to address this research gap. The study examined care planning for children upon parental arrest, sentencing and imprisonment, stability of care arrangements and primary carer prisoners' involvement and satisfaction with care planning. Around one third of prisoners had discussions regarding children's care arrangements at arrest and imprisonment, although the issue was more commonly raised at sentencing. While there was much variation in the stability of care arrangements, children placed in out‐of‐home care experienced the most instability. A minority of prisoners reported being involved in care planning and decision‐making for children upon imprisonment, and around one third rated care planning process poorly. Prisoners were more satisfied with care planning when there were fewer movements of children, where prisoners felt involved with decision‐making, and when police officers, lawyers and corrections staff inquired about the welfare of their children. Implications for policy and future research are discussed.     

Risk,resilience and identity construction in the life narratives of young people leaving residential care

The role of residential care for children has developed very differently internationally, but in all cultural contexts, there are questions about the extent to which it can help young people recover from high risk backgrounds. In the UK, residential care has come to be seen as the placement of last resort, yet new government guidance on permanence has suggested that residential care can provide security and a sense of belonging. Narrative analysis of interviews with 20 care leavers identified their different pathways from birth families through residential care to early adulthood. Some experienced a transformation from a negative sense of self as victims or ‘bad children’ to survivors, while others continued to struggle. Key to successful turning points were four interacting factors, all associated with resilience; connection, agency, activity and coherence. These narratives revealed the importance of nurturing relationships and a sense of ‘family’, and also the role of support after leaving residential care, when transitions workers helped them to move on but stay connected. The study highlighted how residential care leavers from adverse backgrounds attribute very different meanings to their experiences, which affects identity construction, resilience and the need for support.     

Is the Lack of Specific Lesbian,Gay, Bisexual,Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) people frequently report negative health care encounters. Medical professionals may inadequately manage LGBTQ persons’ health if they have not received training in this area. An anonymous survey measuring efficacy in health situations among LGBTQ persons was answered by 166 medical students across all years of a UK university. Results show that 84.9% of participants reported a lack of LGBTQ health care education, with deficits in confidence clarifying unfamiliar sexual and gender terms, deciding the ward in which to nurse transgender patients, finding support resources, and discussing domestic abuse with LGBTQ patients. Most participants reported that they would not clarify gender pronouns or ask about gender or sexual identity in mental health or reproductive health settings. Participants reported infrequently observing doctors making similar inquiries. Participants held positive attitudes toward LGBTQ patients, with attitude scores positively correlating with LGBTQ terminology knowledge scores (r_s = 0.5052, p < .01). Addressing gender identity and sexuality issues within medical curricula may remove barriers to accessing health care and improve encounters for LGBTQ patients.     

Exploring Perceived Discrimination Among LGBT Individuals in Turkey in Education,Employment, and Health Care: Results of an Online Survey

This article explores the discrimination practices encountered by lesbian, gay, bisexual, and transgender (LGBT) individuals in education, income, employment, and health care in Turkey. Limited quantitative data on LGBT individuals are available in Turkey. This study collected data from 2,875 LGBT individuals through a Web-based survey. The findings suggest that LGBT individuals report perceived direct and indirect discrimination in accessing education, employment, and health care. In a country where LGBT rights are not yet recognized and antidiscrimination legislation covering sexual orientation and gender identity is still nonexistent, findings demonstrate perceived discrimination of LGBTs rarely turns into a legal complaint. Even when they do, most LGBTs in our sample report that they did not feel that the justice system addressed their grievances.     

Problematising Australia's Nanny Pilot Program as evidence‐based policy: A reconstruction of the problem of childcare

In a notable departure from long‐standing childcare policy in Australia, in January 2016 fee relief was extended to nannies providing in‐home care in a 2‐year pilot program. This policy is significant as fee relief is not tied to the meeting of regulatory requirements designed to ensure quality early learning and care for young children. Drawing on Carol Bacchi's approach to policy analysis, this paper extends previous problematising of evidence‐based policy by highlighting the value of first considering how a policy ‘problem’ has been constructed. We propose that the nanny pilot is an ideologically driven policy that has emanated from a construction of childcare that is adult (parent)‐centred and marginalises the needs and interests of young children. Accordingly, certain evidence is privileged while other evidence is ignored, with the ensuing policy focused on economic imperatives rather than quality early learning and care experiences for young children. We draw on an analysis of parent, peak body and researcher submissions to the Productivity Commission's 2013–2014 childcare inquiry, nanny‐focused research, and data from three national surveys to explore the limitations of such a policy approach. The utility of problem reconstruction as a means of disrupting policy‐informed evidence and the legitimisation of purported evidence‐based policy is considered.     

Stepwise Psychosocial Palliative Care: A New Approach to the Treatment of Posttraumatic Stress Disorder at the End of Life

Although evidence-based therapies for Posttraumatic Stress Disorder (PTSD) exist for physically healthy populations, these often do not adequately address PTSD in dying patients. Particularly because these interventions require 8–16 weekly sessions, and the median stay in U.S. hospices is 17.5 days (National Hospice and Palliative Care Organization [NHPCO], 2015 National Hospice &; Palliative Care Organization (NHPCO). (2015). NHPCO Facts and figures: Hospice care in America. Retrieved from http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf. [Google Scholar]), there is a potentially serious timing mismatch. Moreover, these treatments may temporarily increase trauma symptoms (Nishith, Resick, &; Griffin, 2002 Nishith, P., Resick, P. A., &; Griffin, M. G. (2002). Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 70, 880–886. doi:10.1037//0022-006x.70.4.880[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), resulting in some patients dying in greater distress than had they not received care. The Stepwise Psychosocial Palliative Care (SPPC) model presented in this article compensates for these difficulties by embracing a palliative care approach to PTSD. Although it utilizes techniques drawn from existing PTSD interventions, these are re-ordered and utilized in a time-responsive, patient-centered manner that takes into account prognosis, fatigue, and logistical concerns. The SPPC approach is further considered with respect to existing social work palliative care competencies (Gwyther et al., 2005 Gwyther, L. P., Altilio, T., Blacker, S., Christ, G., Csikai, E. L., Hooyman, N., … Howe, J. (2005). Social work competencies in palliative and end-of-life care. Journal of Social Work in End-of-Life &; Palliative Care, 1, 87–120. doi:10.1300/j457v01n01_06[Taylor &; Francis Online] , [Google Scholar]) and a case study is used to demonstrate its application.     

Developing a Palliative Radiation Oncology Service Line: The Integration of Advance Care Planning in Subspecialty Oncologic Care

Within radiation oncology, there is often minimal attention on radiotherapy with palliative benefits due to the overlying focus on curative treatments. Historically at the University of Pennsylvania, advanced-stage patients are cared for by cancer site-specific teams rather than a more rapid treatment service model that focuses on patients’ symptom needs and larger clinical issues within a palliative framework. Thus, the University of Pennsylvania created a designated palliative radiation oncology team to focus on the complex medical and relational issues of metastatic cancer patients. Social workers play a critical role in patient and family conversations about advance directives, care needs, and end-of-life goals and fears as treatment regimens and outcomes continue to unfold. The palliative radiation oncology social worker developed and instituted a new, formalized assessment tool called the “palliative radiation oncology psychosocial care plan” in the electronic medical record. A retrospective analysis of 26 palliative radiation oncology patients under treatment between February and August 2016 was conducted. Of these patients treated with palliative radiation, 19% completed an advance directive after the social work intervention. This model highlights advance care planning as a best practice and encourages end-of-life discussions as a routine part of the oncology workflow.