When Therapy Ends: A Qualitative Study on Termination Processes in Youth With a History of Residential Care

Two studies were carried out to investigate the relationship between coping styles and co-morbid depression in people adjusting to the onset of psychosis. Evaluative thinking and early attachment experiences were also examined. In Study 1, a 39-item Recovery Style Questionnaire (RSQ) was developed to measure recovery style in people with psychosis, based on McGlashan, Levy & Carpenter's (1975) interview measure of recovery style. Fifty-six participants completed both the RSQ and McGlashan's interview-based measure. Study 2 explores the relationship between these styles of recovery, depression and early childhood attachment experiences. Thirty-six people participated. The RSQ was both reliable and correlated highly with McGlashan's interview-based measure. We found that the RSQ, in keeping with the interview-based measure, was bimodally distributed, thus supporting McGlashan's contention that they define two distinct recovery styles termed 'integration' and 'sealing over'. As predicted, 88 per cent of the 'sealers' were moderately to severely depressed compared to 52 per cent of the 'integrators' who were mildly depressed with no members of the 'integration' group experiencing moderate to severe depression (p < .0003). Patients who employed the sealing over recovery style also made significantly more negative self-evaluations than did patients in the integration group and also perceived their parents to be significantly less caring than those in the integration group. These findings are explained in terms of a multi-axial model incorporating personality structure and development as well as mental disorder. It is suggested that those individuals with a poorly developed sense of self defend against the threat of psychosis using denial. Clinical implications are discussed and more research is suggested to further investigate the links between evaluative and inferential thinking in co-morbid depression, and how such thinking relates to early childhood experience.

Review question/objective The qualitative and quantitative objective of this review is to scope the extant knowledge about family involvement in decision making for people with dementia living in residential aged care. More specifically, the review question/s are: •Who are the decision makers for people with dementia living in residential care? •What is the experience of decision making for family members in the residential care setting? •What are the barriers or facilitators to decision making by families? •What is the impact of decision making processes on family members? •What is the impact of collaborative decision making with family on the person with dementia? • What processes or strategies do family decision-makers use? Inclusion criteria Types of participants This review will consider studies that include people with dementia who are living in residential aged care, their families and care staff. For the purpose of this review, the definition of “dementia” is not restricted to any specific diagnosis, stage or degree of severity. There is no age limit on participants included, provided they are living in residential aged care. Care staff may include any and all types of staff involved in providing care to people with dementia in residential aged care, including but not limited to nursing staff, medical staff and direct care staff. Types of intervention(s)/phenomena of interest This review will consider both quantitative and qualitative studies that investigate involvement of family members in decision making for people with dementia in a residential aged care setting. For this systematic review, decision making for people with dementia in a residential aged care setting refers to decisions relating to the physical, psychosocial, spiritual and emotional domains of care, for example decisions relating to advance care planning, decisions regarding clinical care, decisions regarding end-of-life care, and decisions regarding leisure and lifestyle. Types of outcomes This review will consider studies that investigate or discuss who the decision makers are in care for people with dementia and how decisions are made, what processes assist families in decision making and what are the barriers or facilitators to collaborative decision making by families, as well as the impact of decision making processes on family members and the impact of collaborative decision making with family on the person with dementia. The review will explicitly exclude studies that are solely concerned with decisions about whether to enter residential aged care or decisions regarding financial issues; however where this data forms part of a larger study, the study may be included but this data will not be extracted.

Understanding and addressing Child Sexual Exploitation (CSE) in residential care in Northern Ireland using a qualitative case study design: The residential social care worker perspective

The capacity to form strong intimate relationship with others is considered as an essential developmental task and a principal feature of effective personality development. Consequently, there are different theories that attempted to explain how social relationship is formed. However, review of related literature on such relationship shows that attachment theory has become prominent theory to explain it. The purpose of this study is to examine the influence of early parental (care giver) attachment experience on adult romantic attachment using attachment theory as a framework. Cross-sectional descriptive survey design was used. A total of 306 (159 female and 147 male) participants were included from community based sample. Three Kebeles in Yeka sub-city of Addis Ababa were selected randomly. Data were collected on adult attachment and perception of early parental attachment experience. The constructs were measured by Experience in Close Relationship Scale-Revised and Inventory of Parent Peer Attachment. Pearson correlation and linear multiple regressions were run to investigate the association and prediction among variables under study respectively. The result confirmed that perception of early attachment experience did not predict adult romantic attachment but insignificantly related. Consequently, the relationship between perception of early parental attachment experience and adult romantic attachment style should be studied by fellow researchers to make the study more replicable in the future.

The objective of this scoping review is to examine and map knowledge of nursing provisions for self-determination while providing care to clients with cognitive impairment in residential aged care facilities. Maintaining the ability to have choices and to make decisions about daily activities is important for older adults. In residential aged care facilities, nurses' can be challenged to preserve clients' self-determination in favor of ritualistic care routines and a perceived duty to care. Moreover, nurses may perceive that their professional responsibilities to protect clients requires them to guard against decisions that are considered unwise or pose a risk to clients' health or safety. Insight into how nurses negotiate choice with clients with cognitive impairment who are living in a residential care facility will provide an in-depth understanding of the role self-determination plays in clients' lives. The scoping review will consider research and narrative reports on nursing provisions for self-determination in clients with cognitive impairment who are living in a residential aged care facility. The concepts of interest are self-determination and nursing provisions. Self-determination is defined as client choice and nursing provisions are the intentional reactions to clients' expressed choices. This scoping review will aim to locate published and unpublished literature employing a three-step search strategy. Only papers published in English from 1995 onward will be included. Data extracted from included papers will outline details on the participants, context, strategy, activity, and outcomes. Extracted data will be reported in a tabular form and presented narratively to address the review objective.

This report examines young adults' states of mind regarding their early attachment experiences in relation to the observed and perceived quality of their sibling relationships. Sixty sibling pairs (18-25 years of age) were (a) administered the Adult Attachment Interview (George, Kaplan, & Main, 1985), (b) videotaped during a conflict resolution task, and (c) asked to describe the quality of their relationship using the Adult Sibling Relationship Questionnaire (Stocker, Lanthier, & Furman, 1997). As hypothesized, dismissing states of mind were associated with lower levels of positive and negative affect while participants attempted to resolve an area of conflict with a sibling as well as with relatively low levels of reported warmth in the relationship. In contrast-but also in line with predictions-preoccupied states of mind were associated with heightened expression of negative affect toward a brother or sister, and the siblings of highly preoccupied individuals reported more conflict in their relationships. Findings provide further support for the importance of young adults' representations of childhood attachment experiences with respect to the quality of their adult relationships. In addition, this study extends previous findings regarding the significance of dismissing versus preoccupied states of mind by demonstrating that these dimensions are differentially associated with behavioral and self-reported aspects of sibling relationship quality in early adulthood.

Review question/objective The qualitative and quantitative objective of this review is to scope the extant knowledge about family involvement in decision making for people with dementia living in residential aged care. More specifically, the review question/s are: •Who are the decision makers for people with dementia living in residential care? •What is the experience of decision making for family members in the residential care setting? •What are the barriers or facilitators to decision making by families? •What is the impact of decision making processes on family members? •What is the impact of collaborative decision making with family on the person with dementia? • What processes or strategies do family decision-makers use? Inclusion criteria Types of participants This review will consider studies that include people with dementia who are living in residential aged care, their families and care staff. For the purpose of this review, the definition of “dementia” is not restricted to any specific diagnosis, stage or degree of severity. There is no age limit on participants included, provided they are living in residential aged care. Care staff may include any and all types of staff involved in providing care to people with dementia in residential aged care, including but not limited to nursing staff, medical staff and direct care staff. Types of intervention(s)/phenomena of interest This review will consider both quantitative and qualitative studies that investigate involvement of family members in decision making for people with dementia in a residential aged care setting. For this systematic review, decision making for people with dementia in a residential aged care setting refers to decisions relating to the physical, psychosocial, spiritual and emotional domains of care, for example decisions relating to advance care planning, decisions regarding clinical care, decisions regarding end-of-life care, and decisions regarding leisure and lifestyle. Types of outcomes This review will consider studies that investigate or discuss who the decision makers are in care for people with dementia and how decisions are made, what processes assist families in decision making and what are the barriers or facilitators to collaborative decision making by families, as well as the impact of decision making processes on family members and the impact of collaborative decision making with family on the person with dementia. The review will explicitly exclude studies that are solely concerned with decisions about whether to enter residential aged care or decisions regarding financial issues; however where this data forms part of a larger study, the study may be included but this data will not be extracted.

This essay reviews recent research about infant attachment, then discusses the implications of this research as they relate to the following specific manifestations of children’s spirituality: faith, wonder, relational consciousness, flow (as in a sense of wholeness or unity), and compassion, in the light of other research on children’s spirituality. In each of these areas links can be found between the security of an infant’s attachment experiences and later manifestations of spirituality, although many gaps in relevant knowledge remain to be filled. The essay concludes that early attachment experiences are spiritually significant.

Several studies document the adverse educational prospects for both immigrant-origin as well as out of home placed children and youth. Few studies have examined the educational and employment outcomes of migrant-origin young adults with a history of out-of-home care (OHC), which is the aim of our study. Methods. We studied all subjects born in 1976 to 1995 abroad and immigrated to Finland as underage persons prior to 2010 (N = 20 037), comparing them to children born in Finland to foreign born parents (N = 3198) and a matched random sample of host population (N = 23 187) according to register data 1991 to 2015. We formed OHC alumni and non-OHC alumni groups among refugee-origin born abroad and in Finland, non-refugee-origin born abroad and in Finland as well as native Finns group. Logistic regression analysis was used in which age of the child in the first placement, number of placements and the type of the first place were adjusted. Results.Minors both with refugee and non-refugee background born in Finland were more likely than native Finns to be placed in OHC. A history of OHC predicted less chance of degrees completed and being employed compared to non-OHC peers in all study groups. Refugee background born abroad having history in OHC had lower educational and employment outcomes as young adults compared to other OHC groups. Education made difference since immigrant background having OHC history and post-compulsory degree had two times higher likelihood of being employed. The first OHC during teenage years decreased odds for post-compulsory education but increased odds for employment. Multiple placements in OHC decreased a youth’s chances of completing degrees and employment Key messages • Education made difference since persons with OHC history and degrees done had two times higher likelihood of being employed. • Refugee origin OHC alumni were in the most vulnerable position with less degrees and less employment, and thus they need any support in their studies.

This book fills major gaps in knowledge about residential care of children, and is sure to inform ongoing debates within and between nations about the appropriate use of such institutions. Each “case study” chapter provides a rich description of the development, current status, and future of residential care in countries from Brazil to Botswana. Chapters describe how residential care is defined in the country in question, how it has evolved over time, including its history, trends over time, and any “landmark” events in the history of residential care. The chapters examine factors (historical, political, economic, ideological, and cultural) that have contributed to the observed pattern of development of residential care and provide a description of the current state of residential care (number of children in care, ages, average length of stay, reasons that children/youth are placed in residential care, etc.). Lastly, each case study describes expected future directions for residential care and potential concerns. Two integrative chapters provide a critical cross-national perspective, identifying common themes, analyzing underlying factors, and speculating about the future of residential child care across the globe.

In response to the worldwide ageing trend, international policy and practice focus on ageing-in-place to support self- and informal care rather than formal and professional care, which entails older people ending up in residential care as a ‘last resort’ that is heavily under pressure. We adopt a socio-spatial theoretical perspective to investigate how we might transform residential elderly care as a space for human flourishing that fosters the freedom of action of people with young-onset dementia. The article is based on a qualitative study in a residential elderly care facility in Flanders (the Dutch-speaking part of Belgium), in which a triangulation of research methods is used. The article discusses five key findings, related to the ambiguous meaning of several places: (1) The entrance: a space of coming, yet less of going; (2) The common living room: always chaos is also a way of structuring; (3) The private living room: at the intersection between the personal and the communal; (4) The hallway: a not-yet discovered pearl; and (5) The environment: creating a relationship between the inside and outside world. We conclude that organisational policy play a key role in establishing enabling socio-spatial circumstances for both people with young-onset dementia and professionals.

BackgroundAdolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled “Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions”.MethodsThe study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups.DiscussionThis study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels.Trial registration {2a and 2b}ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.

Background Migrants with dementia living in residential care may be at risk of disengagement. Objective To synthesize research relating to the meaningful engagement of migrants with dementia who are living in residential care. Method Mixed studies systematic review following PRISMA guidelines. Nine electronic databases were searched for relevant studies. Studies were eligible for inclusion if they reported original research relating to meaningful engagement of migrants with dementia living in residential aged care and were published in English. Two independent reviewers screened the title and abstracts, full texts of eligible studies and conducted a quality appraisal of included texts. A convergent qualitative synthesis approach was used. Results From 1460 articles, 14 papers representing 12 studies were included. Facilitators of meaningful engagement included: the presence of cultural artefacts in the care environment, the use of multimodal communication and a shared but flexible understanding of residents’ culture. Barriers were the absence of a common language and a task-orientated approach to care. Conclusions Migrants with dementia who are living in residential care are at increased risk of disengagement. Our review highlights the need for culturally congruent residential care to go beyond issues of language and to consider how occupations can be tailored to support ongoing participation and engagement.

The majority of older Australians, some of whom live in retirement villages, wish to remain living in their own home, receiving care in the community when their health and/or other circumstances change. Current statistics show that 3.7% of people aged 65 years and over live in a retirement village in Australia. However, residential aged care will still be required for some highly dependent members of the older population. This qualitative Australian study examined the transition into residential care from one form of community housing, the retirement village. In-depth interviews with 33 older people and 48 family members were conducted to illuminate the key issues and factors which influence the move of older people from retirement villages to residential aged care. Analysis of the data revealed the move to be influenced by: health-related crises; the creation of doubt as to ability to cope in the retirement village; the need for more or different care or support services; the desire for independence; assumptions about being able to move into the residential aged care facility co-located with the retirement village; availability of a place; navigating the system; and desirable aspects of a residential aged care facility. The findings of the study provide a description of the transition process from the perspectives of those directly affected, and contribute to the development of best practice in the provision of support to residents living in retirement villages and the community in general.

ABSTRACTCare for children in residential settings is popularly characterised as the last resort for children who have had multiple failed placements and often high levels of need, requiring therapeutic help. It is often assumed that children will leave residential care for independent living. Using administrative data for a six-year period (2008–2014) for children “looked after” in Wales, univariate and bivariate analyses were conducted to provide a characteristic profile of the residential child care population. Of those placed in a residential setting, the vast majority of children were voluntarily placed and the most common reason for leaving residential care was going home. A similar number of children left residential care to move back to a family setting as entered residential care from a family setting, which challenges the assumption of residential care as necessarily the final destination in a troubled care history. The fact that large numbers of children are placed voluntarily in residential care might suggest some potential for preventing some of these placements and keeping children at home with support. Appropriate measures are needed to support children returning from residential care to live with birth families, as well as support for independent living.