Alternative Care Settings Research Articles

Bouncing Back: Hospital Reliance On Transitional Care Beds – A Disservice To Patients? A Review Of Readmission Rates

Abstract Background The Health Service Executive (HSE) developed an Urgent and Emergency Care (UEC) Operational Plan in 2023. One UEC action was an aim to transfer “clinically appropriate” patients to alternative care settings e.g. Transitional Care Beds (TCBs) to relieve pressure caused by high occupancy rates in acute hospitals. Inclusion criteria for TCB use is ill defined and we sought to evaluate their usage. Methods Retrospective analysis of characteristics and readmission rates (RAR) of patients discharged from a tertiary hospital to TCB from Oct 1st, 2023 - Jan 1st, 2024. Results 158 patients were discharged from hospital to TCBs. 49% (n=77) were female, mean [SD] age 77.82 [10.09] years. The median length of stay (LOS) was 15 days. 50% (n=79) were discharged from surgical services, 40.5% (n=64) from medical teams, 8% (n=13) from oncology services, 7% (n=11) from geriatric medicine and 1% (n=2) from ED. 27% (n=43) had a “fall” documented as their discharge diagnosis. 32% (n=51) of patients were readmitted within 90 days, 11% (n=18) within 30 days and 4% (n=6) within 14 days. 30% (n=15) were readmitted directly from TCB. Average time between discharge and readmission was 44.7 days. Median LOS on readmission was 10 (IQR 15.5 days). 9% (n=14) had an eventual discharge to long term care (LTC) either from a subsequent admission or transitioned directly from TCB. 6% (n=10) of patients died. Conclusion Of those readmitted, one third were directly from TCBs suggesting discharge to TCB may have been premature and patient selection inappropriate subsequently resulting costly readmissions. Although interventions are needed to relieve capacity pressure in hospitals, greater emphasis needs to be placed on access for patients to designated rehabilitation programmes. We should aim to support older adults following acute hospital admissions by carrying out comprehensive geriatric assessment to maximise independence and reduce likelihood of hospital readmission or transition to LTC.

The scope of practice of geriatric dentistry in British Columbia (Canada): An exploratory study.

The oral health needs of frail older adults are increasing with an aging population in Canada. The objective of this study was to explore the perceptions of dentists in British Columbia regarding their view of geriatric dentistry as a distinct scope of practice and in relation to special needs dentistry. Qualitative data were gathered thorough semi guided interviews of a purposeful sample of dental clinicians, educators and members of organized dentistry with specialized knowledge of oral health for frail older adults. Interviews were transcribed, coded, and analyzed using a thematic approach. Thematic saturation was reached with the 10 participants in this study. Through the method of interpretative description, patient, dentist, and systemic factors that shaped scope of practice for geriatric dentistry were identified as well as the broader skill sets required for geriatric dentistry. The study found that participants perceived geriatric dentistry as unique scope of practice from general dentistry requiring special knowledge in the management of challenges associated with aging with frailty as well as the ability to work in long-term care. Similar to special needs dentistry, geriatric dentistry requires person-centered care and emphasized the need for interprofessional collaboration in alternative care settings.

The Impact of COVID-19 on Care Leavers

The survey of the COVID-19 outbreak focused on studying the impact and long-term consequences on care leavers, especially residential care leavers who are living independently. Employment, education, physical health, hygienic practices, psychosocial and emotional health, and coping strategies adopted by care leavers were studied. Bronfenbrenner’s Ecological Systems Theory (1979 ) was used to study the impact of COVID-19 on care leavers at every system level in Sri Lanka. The methodology adopted was mixed method. The data collection was mainly a quantitative survey. Focused group discussion and semi-structured interviews were used to elicit qualitative aspects of survey findings. The findings highlight that care leavers were primarily female (69%) and young adults between the ages of 16 and 28 (61%); the majority of care leavers (80%) lived with their families and only 20% lived alone. Care leavers were well adapted to precautionary measures to prevent COVID-19. This study on care leavers has shed light on various social and economic issues, including care-leaving debt, lack of access to digital learning, food insecurity and homelessness, as well as lack of access to a continuum of care and mental health services. The impact was more severe care leavers’ employment and educational opportunities, which led to long-term consequences on their life cycle. The absence of income maintenance or social protection nets could further affect care leavers’ long-term consequences. The research recommends a range of interventions to support youth leaving alternative care settings and to promote their independence and dignity.

Motives of patients presenting independently at the emergency department-aprospective monocentric observational study

In the ongoing professional, societal, and political discussion, the hypothesis is repeatedly put forward that alarge portion of patients who independently visit the emergency department could also be treated in other care settings such as by ageneral practitioner, the statutory medical on-call service, or in emergency clinics. Various reasons are cited for why these alternative care settings are not utilized in these cases. This study investigates the motives of patients who presented independently at the emergency department, as well as the socio-demographic parameters of this study cohort. The survey was carried out as part of aprospective monocentric observational study of internal medicine patients at auniversity emergency department. Atotal of 1086 patients were included in the study. In total, 33% of the study participants visited the emergency department based on aphysician's recommendation or referral instead of opting for an alternative care option. The main reason for visiting the emergency department was the subjectively assessed urgency of their symptoms. Among the patients who presented independently at the emergency department, 28% required further inpatient care during the course of treatment. Awareness of alternative care pathways, such as utilizing emergency medical services, seeking care from the statutory medical on-call service, or visiting an emergency clinic, was low. Emergency departments remain an important point of contact for patients who present there independently, without being brought by emergency medical services. The motives behind why patients choose avisit to the emergency department over treatment in an alternative care setting vary. If alternatives are to be used instead of emergency departments, structures first need to be established or expanded.

What is in a space? Exploring experiences providing or receiving patient care in unique spaces for patients waiting to transition to their next point of care in Ontario, Canada

Introduction: Delayed discharge is a key challenge for health systems globally. Pandemic-related capacity pressures on hospitals have increasingly led to patients being moved to unique spaces (overflow units, hotels) while they wait to transition to their next point of care. However, it is unclear how patient care is managed and coordinated in these spaces or how patients and caregivers experience care in these environments.
 Rationale/Objective: Our study aimed to understand how to optimize care experiences and outcomes for patients with a delayed discharge, their families and care providers. The purpose of our study was to learn about people’s experiences in unique spaces, including what works well and what needs to improve. 
 Methods: Using a qualitative descriptive design, we conducted in-depth, semi-structured interviews with patients/caregivers (n=9) and care providers (n=20; e.g., nurses, rehabilitation therapists, physicians, discharge planners) who had experience with receiving or providing care in a unique space. We interviewed participants from three different unique spaces associated with a hospital across rural and urban health regions in Ontario, Canada: a hotel previously used for patient and caregiver accommodations while receiving care away from home (beside hospital), a structured, heated tent (hospital parking lot) and a clinical building (1 hour away from hospital). Interviews were transcribed and a codebook was developed and applied to all transcripts. Thematic analysis was used to analyze the transcripts, specifically focusing on key challenges and opportunities.
 Results: Patient, caregiver and care provider experiences in these unique spaces included positive aspects, such as care teams focused on facilitating integrated care transitions, the opportunity to develop a collaborative team culture from the ground up and having increased interdisciplinary patient assessments. Areas of improvement were also described across interviews, such as the need for adequate space and infrastructure for optimal patient care and safety, more integration of information sharing about patient care and journeys between and across providers, patients and caregivers, more resources and support from the associated hospital and clear patient eligibility criteria for care provider referrals.
 Lessons learned: Unique spaces have the potential to be alternate care settings when hospitals are managing capacity pressures now and in the future; however, hospitals considering moving patients with delayed discharge to these spaces should consider both the opportunities and benefits of providing care within these environments compared to traditional hospital units. It is also important for hospitals to understand the challenges associated with providing care in these settings and develop plans to mitigate these challenges. 
 Next steps: These findings provide learnings to inform a co-design initiative with patients, caregivers and care providers to identify best practices and resources for providing or receiving care in unique spaces that responds to patient needs as the health system continues to look to alternate care settings to ease pressures. This work will have implications on how integrated health care services are implemented in unique spaces so that patients experience a continuum of care both while they wait and as they transition to new points of care.

Preventive interventions to improve older people's health outcomes: systematic review and meta-analysis.

Systematic reviews of preventive, non-disease-specific primary care trials for older people often report effects according to what is thought to be the intervention's active ingredient. To examine the effectiveness of preventive primary care interventions for older people and to identify common components that contribute to intervention success. A systematic review and meta-analysis of 18 randomised controlled trials (RCTs) published in 22 publications from 2009 to 2019. A search was conducted in PubMed, MEDLINE, Embase, Web of Science, CENTRAL, CINAHL, and the Cochrane Library. Inclusion criteria were: sample mainly aged ≥65 years; delivered in primary care; and non-disease-specific interventions. Exclusion criteria were: non-RCTs; primarily pharmacological or psychological interventions; and where outcomes of interest were not reported. Risk of bias was assessed using the original Cochrane tool. Outcomes examined were healthcare use including admissions to hospital and aged residential care (ARC), and patient-reported outcomes including activities of daily living (ADLs) and self-rated health (SRH). Many studies had a mix of patient-, provider-, and practice-focused intervention components (13 of 18 studies). Studies included in the review had low-to-moderate risk of bias. Interventions had no overall benefit to healthcare use (including admissions to hospital and ARC) but higher basic ADL scores were observed (standardised mean difference [SMD] 0.21, 95% confidence interval [CI] = 0.01 to 0.40) and higher odds of reporting positive SRH (odds ratio [OR] 1.17, 95% CI = 1.01 to 1.37). When intervention effects were examined by components, better patient-reported outcomes were observed in studies that changed the care setting (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.17, 95% CI = 1.01 to 1.37), included educational components for health professionals (SMD for basic ADLs 0.21, 95% CI = 0.01 to 0.40; OR for positive SRH 1.27, 95% CI = 1.05 to 1.55), and provided patient education (SMD for basic ADLs 0.28, 95% CI = 0.09 to 0.48). Additionally, admissions to hospital in intervention participants were fewer by 23% in studies that changed the care setting (incidence rate ratio [IRR] 0.77, 95% CI = 0.63 to 0.95) and by 26% in studies that provided patient education (IRR 0.74, 95% CI = 0.56 to 0.97). Preventive primary care interventions are beneficial to older people's functional ability and SRH but not other outcomes. To improve primary care for older people, future programmes should consider delivering care in alternative settings, for example, home visits and phone contacts, and providing education to patients and health professionals as these may contribute to positive outcomes.

Spirituality as a Protective Factor

Adults who were separated from parental care as children and resided in alternative care settings often experience difficulties throughout their lifespan. Thus, it is important to explore factors that lead to better outcomes. Spirituality is one protective factor that has received attention in academic literature in recent years. However, little work has examined spirituality in this population or the specific ways it impacts wellbeing in adulthood. Using thematic analysis, the current study explored the specific ways spirituality serves as a protective factor in a multinational sample of 267 individuals with care experience. Data revealed six spirituality-related themes: 1) relationship with God, 2) spiritual community support, 3) spirituality as a component of identity development, 4) a belief in a higher purpose, 5) spirituality-motivated servanthood, and 6) access to spirituality-based teachings and teachers. Based on these findings, we propose data-informed recommendations to improve services for children separated from parental care.

‘Doing family’ in adversity: Findings from a qualitative study exploring family practices in alternative care settings in Thailand

AbstractThis paper presents findings from a qualitative study that explored children's and families' experiences of alternative care in Thailand. The study used arts‐based methods to engage 160 children living in a range of care settings. This included government and NGO‐run residential care settings (RCS), children's villages, Buddhist temples, migrant learning centres and foster care homes. Interviews were also conducted with 20 parents/guardians who had placed their children in care. Findings show that despite the alternative care system presenting significant challenges, the participants revealed how they strived to preserve their family connections, and how they are ‘doing family’ in adversity.

Decline in Veterans' Admissions to Nursing Homes During COVID-19: Fewer Beds, More Fear, and Finding Alternative Care Settings.

Examine the decline in admission to community nursing homes among Veterans that occurred following the onset of the COVID-19 pandemic. Multimethods study using Department of Veterans Affairs (VA) purchasing records to examine trends in total admissions and semistructured interviews with staff connected to the VA community nursing home program to contextualize observed trends. All VA-paid admissions to community nursing homes (N= 56,720 admissions) and national data on nursing home admissions from LTCFocUS. Semistructured interviews were conducted with 9 VA staff from 4 VA medical centers working in the VA community nursing home program, including social workers, nurses, and program coordinators. Between April and December 2020, community nursing home admissions among Veterans were 35% lower compared with the same period in 2019. Nationally, total nursing home admissions decreased by 19.6%. VA community nursing home program staff described 3 themes that contributed to this decline: (1) fewer nursing home beds available, (2) lower admissions due to fear of Veterans being exposed to COVID-19 in nursing homes, and (3) leaving nursing homes in favor of living at home with home-based care. The decline in nursing home admissions among Veterans raises questions about how replacing nursing home care in favor of home- and community-based care affects the health outcomes and well-being of Veterans and their caregivers.

The relationship between adverse childhood experiences, health and life satisfaction in adults with care experience: The mediating role of attachment

AbstractAdverse childhood experiences (ACEs) are associated with a plethora of negative outcomes. Research has also found that adults who were separated from parental care and lived in alternative care settings during childhood have high levels of ACEs and are more likely to have poor outcomes. A growing body of research has supported the importance of attachment as a mechanism underlying the relationship between ACEs and adult wellbeing. However, little work has examined the role that attachment may play in the outcomes of adults who resided in residential and foster care during childhood. The current study examined the role of attachment avoidance and anxiety in the associations between ACEs and mental health, physical health, and life satisfaction in a sample of 529 adults with alternative care experience from 11 nations. Attachment avoidance partially mediated the relationship between ACEs and life satisfaction, mental health, and physical health. Attachment anxiety partially mediated the relationship between ACEs and life satisfaction and mental health, but not physical health. Taken together, the present study suggests that both attachment anxiety and avoidance play important, but unique, roles in understanding the relationship between ACEs and health and wellbeing for adults with care experience. Implications and limitations are discussed.

The experience of informal caregiving within Saudi society: expressed needs and expectations

BackgroundEven though informal caregivers have always been a major element within any society, their contribution to the healthcare system has only recently been recognized. Accordingly, the sustainability of their informal social role is becoming a major concern to policymakers. In Saudi Arabia, recognition of informal caregiving is still limited. This study was carried out to investigate the experience of caregiving in informal settings through identifying the needs of the caregivers along with their expectations of the formal system.MethodsA cross-sectional study was conducted to measure the experience of Saudi informal caregivers who were caring for at least one individual with a dependency resulting from either disability, aging, or both. A self-administered questionnaire was designed specifically for this study with 88% reliability. A convenient sample of 300 caregivers was invited electronically through 14 websites supporting families with dependent individuals.ResultsOf the eligible participants (n = 271), about two-thirds were caring for one elderly person or more, while one-third were caring for individual(s) with disabilities. The two groups did not differ in their needs; their greatest perceived needs were necessary equipment for care recipients, free time to socialize, alternative care setting, and proper income. Overall, the needs on the system level were the highest, followed by the needs on the financial level, then on the social level. On the other hand, the caregivers of individuals with disabilities had greater expectations of formal support than caregivers of the elderly. The greatest expectation among the participants was facilitating care recipients’ mobility within their communities. Overall, the expectations of information support were the highest followed by the expectations of financial support and then material support.ConclusionThe participants expressed great expectations of formal support along with some unmet needs. Further research is recommended to emphasize the role of primary caregivers along with the nature of the assistance received throughout the caregiving process. The needs of individuals with dependencies along with those of the caregivers must be considered in the planning process of healthcare services. Finally, the expectations of informal caregivers should lead the priorities of the development decisions of long-term care services.

The Relationship Between Spirituality and Resilience and Well-being: a Study of 529 Care Leavers from 11 Nations.

Research has found that individuals who were separated from parental care and experienced alternative care settings during childhood are more likely to have poor outcomes as adults. This highlights the importance of understanding factors that are related to resilience and well-being for care leavers. A growing body of research has supported the importance of spirituality in our understanding of resilience and well-being. However, little work to date has examined the relationship of spirituality to outcomes in care leavers. The current study investigated the relationships between spirituality, resilience, well-being, and health in a sample of 529 care leavers from 11 nations. It also examined how different themes of spirituality were related to specific outcome variables. Data revealed that spirituality was significantly associated with higher life satisfaction, better mental and physical health, and more resilience even when accounting for current age, gender, age at separation, Human Development Index scores, and childhood adversity. Furthermore, findings indicate that different themes of spirituality are related to specific outcome variables, even when accounting for demographic information. Findings indicate that spirituality may play an important role in resilience and well-being for care leavers. Implications and limitations are discussed.

End-of-life care for people with dementia on a green care farm during the COVID-19 pandemic: a qualitative study

ObjectiveGreen care farms combine agriculture production with health-related, social and educational services. In the Netherlands, they form an alternative to traditional nursing homes for people with dementia. Green care farms that offer 24-hour care, also offers end-of-life care. To date, little is known about end-of-life care for people with dementia on green care farms. This study aimed to explore the experiences of healthcare workers and family caregivers with end-of-life care for people with dementia who died on a green care farm.DesignAn explorative, descriptive qualitative design with a phenomenological approach.Setting and participantsA purposive sample of 15 participants – seven healthcare workers and eight family caregivers - from three green care farms in the Netherlands.MethodsSemi-structured, in-depth interviews were conducted to explore participants’ experiences with end-of-life care, including topics such as advance care planning, the influence of COVID-19, and bereavement support. Transcripts were thematically analysed using Braun and Clarke’s approach.ResultsFour main themes were extracted: 1) tailored care and attention for the individual resident, 2) reciprocal care relationships between healthcare workers and family caregivers, 3) compassionate care and support in the dying phase, and 4) the influence of COVID-19 on end-of-life care.Conclusion and implicationsThe overall experience of the healthcare workers and family caregivers was that end-of-life care offered on green care farms is person-centred and compassionate and is tailored to the person with dementia and their family caregivers. Despite the COVID-19 pandemic, healthcare workers and family caregivers were satisfied with end-of-life care on the green care farms. Green care farms may offer a valuable alternative care setting for people with dementia in their last phase of life. More research is needed to investigate green care farms’benefits compared to other, more traditional settings.

130 Novice-Performed Point-of-Care Ultrasound for Home-Based Imaging

As delivering health care in alternative settings becomes more common, portable imaging technologies aiding medical decision-making will be key. Patient-performed point-of-care ultrasound (POCUS) scanning may be feasible for use in home-based medical care. Here, we investigated whether novice users can obtain lung ultrasound (LUS) images via self-scanning with similar interpretability and quality as experts.

Balancing Caregiver Resources Provided by Michigan’s Area Agencies on Aging

ABSTRACT Timely linkages are necessary for people with dementia and other disabling conditions to reduce caregiver burnout, prevent unnecessary hospitalization, or placement in alternate care settings. To identify needs, the Caregiver Resource Collaborative conducted a needs assessment of Michigan’s sixteen area agencies on aging (AAA). Responses by the sixteen AAAs to an online questionnaire provided a point-in-time picture of current caregiver assessment and services conducted by AAAs. Fifteen AAAs responded there would definitely or probably be an increase in the number of caregivers. Fifteen responded that they purchase or contract out respite care services. Fourteen stated that they provide some type of direct caregiving resources. Twelve utilize staff to develop and monitor care plans. While some provide training, none of the AAAs provides supportive services. The AAAs anticipate rapidly increasing needs for caregiver supports and services. While each provides different services, demand will continue to grow as the older adult population increases.

Testing the psychometric quality of screening tools for the well-being of children and caregivers in alternative care-settings: a multi-informant study with families in Tanzania

ABSTRACT Given the lack of validated screening tools for the well-being of children and caregivers in family-based care in low-income settings, the present study aimed to test the psychometric quality of two newly developed tools: Scorecard A as a screener for children’s emotional and behavioral problems and Scorecard B as a screener for caregivers’ well-being and resources. The study was conducted within the framework of an ongoing caregiver training program in Dar es Salaam, Tanzania, and included a sample of 124 caregivers and 99 children (57 girls, M age = 9.30, SD = 4.65, range 3–17) divided in three equally sized age groups of preschool (3 to 5 years), primary school (6 to 12 years) and secondary school age (13 to 17 years). Caregivers reported on children’s emotional and behavioral problems using Scorecard A and the Strengths and Difficulties Questionnaire (SDQ) administered as a structured interview. A sub-sample (n = 78) of caregivers participated in another structured interview on various aspects of their well-being and caregiving resources, based on which interviewers rated Scorecard B. Additionally, caregivers completed Scorecard B and measures of their well-being and resources administered as self-report questionnaires. All assessments were conducted twice with an interval of 1 week. Scorecard A showed good internal consistency and test-retest-reliability across age groups and significant associations with the SDQ total score and subscales indicate convergent validity, particularly among preschool-aged children. The internal consistency of Scorecard B was acceptable in the questionnaire and good in the interviewer rating, while re-test-reliability in both modes and inter-rater reliability between interviewer and caregiver rating were moderate. Associations with established measures of well-being and resources provided evidence for convergent validity of Scorecard B. The Scorecards hold promise as brief screening tools to identify children and caregivers with difficulties and evaluate intervention programs in low-resource contexts.

The influence of home care supply on delayed discharges from hospital in England

BackgroundDelayed transfers of care (DTOC) of patients from hospital to alternative care settings are a longstanding problem in England and elsewhere, having negative implications for patient outcomes and costs to health and social care systems. In England, a large proportion of DTOC are attributed to a delay in receiving suitable home care. We estimated the relationship between home care supply and delayed discharges in England from 2011 to 2016.MethodsReduced form fixed effects OLS models of annual DTOC attributed to social care at local authority (LA)-level from 2011 to 2016 were estimated, using both number of days and patients as the dependent variable. A count of home care providers at LA-level was utilised as the measure of home care supply. Demand (e.g. population, health, income) and alternative supply (e.g. care home places, local unemployment) measures were included as controls. Instrumental Variable (IV) methods were used to control for any simultaneity in the relationship between DTOC and home care supply. Models for DTOC attributed to NHS and awaiting a home care package were used to assess the adequacy of the main model.ResultsWe found that home care supply significantly reduced DTOC. Each extra provider per 10 sq. km. in the average local authority decreased DTOC by 14.9% (equivalent to 449 days per year), with a per provider estimate of 1.6% (48 days per year). We estimated cost savings to the public sector over the period of analysis from reduced DTOC due to increased home care provision between £73 m and £274 m (95% CI: £0.24 m to £545.3 m), with a per provider estimate of savings per year of £12,600 (95% CI: £900 to £24,500).ConclusionDTOC are reduced in LAs with better supply of home care, and this reduces costs to the NHS. Further savings could be achieved through improved outcomes of people no longer delayed. Appropriate levels of social care supply are required to ensure efficiency in spending for the public sector overall.

Standardization of a Participatory Questionnaire to Assess the (Fulfilment of) Needs of Children in Care (QANCC) In India.

India has approximately 23 million children without parental care, who need alternative forms of care (MOSPI, 2018). Udayan Care, an NGO, designed an innovative group care model for children and youth in need of care and protection, implementing the indigenously developed LIFE (Living in Family Environment) strategy in 17 Udayan Ghars. (Sunshine Homes).With child participation as a core pillar, Udayan Care developed a Questionnaire to Assess the Needs of Children in Care (QANCC) in 2011, which is to be filled up by children annually, as a longitudinal study. The tool is conceived to ascertain whether children in the Ghars perceived if their rights were being fulfilled and that their needs were being addressed. With "meaningful participation" of children stipulated by the United Nations Convention on the Rights of the Child (UNCRC), the objective was to develop an evidence-based tool to assess the views of children on the services meted out to them, from their standpoint, and inform actual care practices annually. The self-assessment tool consists of questions, assessing the four dimensions of basic/fundamental, emotional, educational, and interpersonal needs, on a four-point Likert rating scale. A convenient purposive sampling is done on children, aged 10 to 18years, who receive care and protection at the Ghars, and have resided there for a minimum of 6months. This paper has two objectives, where at one end, the deductions of the previous years' data are made (2011-12 to 2016-17) with demarcating the differences with year 2018-19 data and at the second level, there is an update on the efforts made to establish the reliability and validity of the tool and create a standardized tool that can be implemented by other child care organizations in India. The paper illustrates how listening to direct voices of children and incorporating their inputs into actual care practice, can go a long way in improving the holistic wellness of children living in an alternative care setting. The results indicate that all needs of the majority of the children in Udayan Ghars.

The role of long-term mentoring in alternative child care settings

BackgroundUdayan Care, an NGO based in New Delhi, India, provides alternative care to ‘Children without Parental Care’, in small-group residential homes. The homes have a Living In Family Environment (L.I.F.E) Model, where ‘Group Care’ ensures that children are loved and cared for by a group of long-term volunteers, called mentor parents, along with other care staff. A novel parenting concept, the mentor parents are ordinary individuals with extraordinary sensitivity, voluntarily committing themselves for life. They instill in children a sense of trust and belonging to the community and are concurrently empowered and fulfilled by the endeavor. ObjectiveThis study attempted to explore the scope and impact of a distinct mentor model in alternative child care, its positive outcomes, and some challenges faced, from the perspective of mentor parents. Participants and settingWith a qualitative research design, interviews were conducted with the mentor parents (n = 21) from Udayan Care, to capture their experiences and perspectives. MethodsThe interviews were conducted using an indigenously developed semi-structured interview guide, and the responses were transcribed, organized, coded, and analyzed using applied thematic analysis. ResultsThe unique roles and responsibilities that mentor parents bring to the care system were identified, along with how they add value to the mentor-mentee relationship. Some challenges in the care practice were also discerned. ConclusionsThis paper gleans mentor perspectives that could be valuable for the design and implementation of mentorship programs, encouraging similar scalable models that could support the growth, development, and outcomes of children in care.

Alternative Care Mechanisms in Jharkhand: Analysing the Implementation Barriers; Its Potential to Prevent Family Separation and Strengthening Family-based Care of Vulnerable Children in Jharkhand

The required operational framework of a community-based care mechanism as envisaged under the Revised Integrated Child Protection Scheme and the National Plan of Action for Children 2016, fails to both prevent and effectively respond to the vulnerabilities of children in need of care and protection. Resonance of such unplanned community programming shifts the focus towards institutionalisation of children, thus grossly violating ‘institutionalization as a measure of last resort’, one of the fundamental principles governing the Juvenile Justice (Care and Protection of Children) Act 2015. The act critically justifies the need to empower vulnerable families to care for children and re-emphasises the preventive role in ensuring family-based care or keep children in alternative care setting. The alternative care (sponsorship and foster care) guidelines in Jharkhand was launched in 2018. Since then, it has been found that the state is struggling to implement it. Though there has been some progress in the sponsorship scheme implementation, the kinship and foster care remains completely neglected. Child in Need Institute (CINI) is partnering with Hope & Homes for Children (HHC) since 2017 for pushing the agenda for deinstitutionalisation of children through a two-pronged approach of model creation and district-level technical support to the ICPS system. Working closely with communities in preventing family separation, led to the understanding that there is a huge need to address the structural gaps for implementing the alternative care guidelines in true spirit. The purpose of the article is to do a systematic analysis of the implementation of the alternative care guidelines in the state and map out the implementation bottlenecks/barriers (systemic, structural and operational), hindering its smooth implementation. Besides that, the article will also try to establish a causal linkage between implementation of alternative care guidelines and dependency on institutional care, thus reflecting the potential of such mechanisms in promoting deinstitutionalisation. The research methodology will be a mix of qualitative and quantitative tools. Tools like content analysis of the key informants’ interviews and case studies will be used to understand the implementation barriers. A quantitative analysis of the secondary data on sponsorship scheme implementation will be done to analyse the gaps. Besides that, the experiences of children and their parents who have been linked with alternative care will also be analysed. District stakeholder consultations in 2 districts will be done to enlist the recommendations for the state. Thus, the key research question that would guide this article are: (a) What are the barriers to implementation of the alternative care program in its current form? and (b) What are the changes that should be made in the guidelines and its implementation process? The article will thus be an advocacy tool for influencing the state government for enhanced priority and investments in alternative care program and reduced focus on institutional care.