Alternative Care Research Articles

A Comparison of Delivery Modalities for Pregnancy Clinical Care Management: Telephonic Versus Video.

Given the high prevalence of maternal morbidity and mortality, it is imperative that maternal health interventions are comprehensively evaluated, so they can be scaled with fidelity. Community-based care management models focused on perinatal health care are a priority for health care systems and payers. Alternative care management delivery modalities, such as video visits, are needed to expand program reach amidst growing system-level challenges. This evaluation explores the feasibility, acceptability, and impact of video versus telephonic care in perinatal care management. Using a mixed methods approach, we implemented a quality improvement project to learn about the integration and impact of video-enabled care into the UPMC Health Plan "Pregnancy Clinical Support" (PCS) care management delivery model. Focus groups were conducted with PCS care managers (CMs) to explore their perspectives on video-visit integration. Video-only members were propensity scores matched to telephonic-only members; statistical comparisons were conducted to assess between-group differences in engagement. PCS CMs discussed ways to structure effective video-visit onboarding, strengths, and drawbacks of video-enabled care, workflow integration challenges, and best practices for introducing video visits to members. Video-only members had significantly (P < 0.0001) more clinical sessions (2.56 ± 1.57 vs 2.05 ± 1.52) and longer case duration measured in calendar days (209 ± 80 vs 169 ± 94) during the 17-month project period than telephonic-only members. Evidence generated provides direct guidance on successfully integrating video visits into workflows of community-based CMs while improving engagement in care across diverse member populations.

Home and family in alternative care – how Finnish legislation creates opportunities for belonging

ABSTRACT Alternative care can be offered through foster family care, residential care or adoption. The need to belong is equal for all groups of children, but the opportunities for creating a sense of belonging for them are different. An analysis of the laws and government propositions steering alternative care in Finland was conducted. The analysis was inspired by Critical discourse analysis (CDA) and performed across cases of the different types of care. The discourse on belonging was operationalised mainly through the concepts of home and family. These concepts were analysed in relation to the spatial, relational and temporal dimensions of belonging. In the laws and legal documents steering alternative care in Finland, adoption is about legal relations, while foster family and residential care concern the environment for upbringing. The opportunities for creating a sense of belonging are very different in the three forms of care. In residential care, legislation in relation to the home and family mainly considers the past; in foster family care, it considers the past and the present; and in adoption, it considers the future. In addition to legislation failing to consider temporal aspects, it also does not recognise the complexity of family life.

The impact of body position on neurofluid dynamics: present insights and advancements in imaging

The intricate neurofluid dynamics and balance is essential in preserving the structural and functional integrity of the brain. Key among these forces are: hemodynamics, such as heartbeat-driven arterial and venous blood flow, and hydrodynamics, such as cerebrospinal fluid (CSF) circulation. The delicate interplay between these dynamics is crucial for maintaining optimal homeostasis within the brain. Currently, the widely accepted framework for understanding brain functions is the Monro-Kellie’s doctrine, which posits a constant sum of intracranial CSF, blood flow and brain tissue volumes. However, in recent decades, there has been a growing interest in exploring the dynamic interplay between these elements and the impact of external factors, such as daily changes in body position. CSF circulation in particular plays a crucial role in the context of neurodegeneration and dementia, since its dysfunction has been associated with impaired clearance mechanisms and accumulation of toxic substances. Despite the implementation of various invasive and non-invasive imaging techniques to investigate the intracranial hemodynamic or hydrodynamic properties, a comprehensive understanding of how all these elements interact and are influenced by body position remains wanted. Establishing a comprehensive overview of this topic is therefore crucial and could pave the way for alternative care approaches. In this review, we aim to summarize the existing understanding of intracranial hemodynamic and hydrodynamic properties, fundamental for brain homeostasis, along with factors known to influence their equilibrium. Special attention will be devoted to elucidating the effects of body position shifts, given their significance and remaining ambiguities. Furthermore, we will explore recent advancements in imaging techniques utilized for real time and non-invasive measurements of dynamic body fluid properties in-vivo.

Considerations for emergency department virtual triage.

Health leaders are increasingly interested in harnessing Artificial Intelligence (AI) to remotely conduct virtual triage for Emergency Department (ED) patients. This study explores equity considerations and patient attitudes to virtual triage in a Canadian ED. A cross-sectional study surveyed 150 ED patients, with 32 additional patients interviewed in-depth. Descriptive statistics and qualitative descriptive methodology were employed. 84.7% of patients would consider virtual triage. 71.3% were comfortable following advice to seek alternate care, including their General Practitioner or virtual ED. Approximately 38.2% of patients >60years would require assistance using virtual triage, with confidence in using technology to direct care decreasing with age. Thematic analysis revealed five key themes: value of decision support; care access expectations; technological literacy demographics; trust in AI; and confidentiality. In conclusion, virtual triage is a viable and promising tool if barriers to technological literacy are addressed, and tools are endorsed by health providers and patients.

Child guidance centres in Japan: Alternative care, social work, and the family

Child guidance centres in Japan: Alternative care, social work, and the family

The Need for a New Approach to MCI Readiness in the Era of Emergency Department and Hospital Crowding.

Emergency department (ED) visit volumes have increased since 2007, with crowding in the United States reaching its highest levels in 2022. During this same period, mass casualty incidents (MCIs) have increased dramatically, both in frequency and severity, across the United States. Resuscitation of trauma patients is a time-sensitive process that requires immediate patient assessment by coordinated clinical teams in order to successfully diagnose and manage life-threatening injuries. To make resuscitation spaces immediately available for incoming patients, typical MCI plans call for rapidly relocating ED patients from their rooms into hallways or transferring them to open inpatient areas. With current levels of crowding, however, such alternate care spaces are often already in use and traditional MCI plans are increasingly unrealistic. With ED crowding worsening and the frequency of MCIs rising, there is a worrisome risk that EDs could fail in their efforts to save patients due to insufficient resources and spaces to meet the demands of critically injured patients. Hospitals must use innovative, novel response strategies to ensure sufficient patient care spaces in a short timeframe to save the most lives possible. In this commentary, we describe the use of buffer zones to help EDs mobilize an effective response to MCIs in the current context of severe hospital crowding.

Exploring Belief Systems in Kinship Fostering Practice in Igbo Indigenous Communities of Southeast Nigeria

ABSTRACTKinship fostering in Igbo indigenous communities is an enduring alternative child care practice that promotes collective responsibility for child care in a family environment. The practice is believed to be fundamental for family and community continuity. Weakening extended family ties and a lack of social work support services in this care arrangement have cast doubt on the continual viability of this alternative child care practice This is an exploratory study using grounded theory. In‐depth interviews with six community leaders and six senior public social welfare officers provided insight on belief systems promoting kinship fostering in Igbo indigenous communities. Findings were thematically analysed to show continuity of lineage, preservation of family name and challenges associated with kinship fostering. Belief systems on kinship fostering provides insights on how children are viewed in Igbo culture, which can help policymakers design intervention programme that are culturally relevant in child‐care formation in Nigeria given challenges in kinship fostering. The study promotes indigenous knowledge that is vital for social work education and practice in Nigeria. Further study suggests exploring the belief of foster children and their experiences in kinship fostering.

Empowering youth in care: the case of emancipatory research with care leavers

New sociology of childhood has emphasized that children are capable of being reflective, of behaving purposively and are able to influence the environment where they live. This concept is also referred to as ‘children as capable agents’ meaning that they can shape the environment. Despite this, children are rarely given the space for participation. The lack of participation is particularly evident within the child protection system, where the tension between children's right to protection and their right to participation becomes even more pronounced. Preventing them from participation is not only a violation of rights but also impacts their capability to exercise social citizenship. This can be particularly detrimental for care leavers who rank among the most socially excluded and disadvantaged groups of young people. This article addresses these issues by presenting the findings of the action-research project CarINg (Empowering Childcare Systems and Supporting Leaving Care from Inside), implemented in Italy and co-funded by the European Union. This research delved into the participation opportunities for care leavers within the care system, with a dual focus on enhancing the local alternative care system and empowering care leavers to actively voice and influence the status quo. Results show how active involvement of care leavers in the protection system and in the production of knowledge can empower them as individuals and enable them to contribute to bringing about change within the alternative care system. Whether all these changes happen depends on the capacity of the institutions to recognize that children are authentic agents and participants of the society.

Effect of insurance type on Management of Vancouver B Periprosthetic Fractures: length of stay, discharge destination and cost implications.

To assess the effect of private versus public insurance on hospital length of stay, discharge destination, and costs in managing Vancouver B periprosthetic femoral fractures (PFF). A retrospective cohort study of PFF patients operatively managed at five public trauma centers. The primary outcome was hospital length of stay. Secondary outcomes included discharge destination and costs related to implants and hospital beds. The study included 195 PFF cases (133 public, 62 private). Private patients had lower ASA scores (2.8 versus 3.1, P = 0.006) and were more likely to come from independent residences (87% versus 74%, P = 0.045). Private patients spent 8 fewer days in the hospital (12 ± 8 versus 20 ± 19 days, P < 0.001) and were more often discharged to rehabilitation (74% versus 48%, P = 0.003). Public hospital costs were higher for public patients ($37 456 versus $25 324, P = 0.005), largely due to longer stays. Implant costs were similar between private and public patients, but patients that underwent revision surgeries increased costs significantly compared to patients that underwent open reduction and internal fixation alone ($6257 versus $3511, P < 0.001). Private insurance was linked to shorter hospital stays and increased discharge to rehabilitation. Public PPF patients incur an average cost of $37 456 for public hospitals, compared to $25 324 for private patients. Delays in public patient rehabilitation access may prolong hospital stays, suggesting a need for alternative care pathways, such as PPF tailored home-based rehabilitation and support programs.

Patient Demographics and Factors Influencing Access to General Practitioner Services for Musculoskeletal Pain in the United Kingdom.

Access to general practitioner (GP) services is essential for managing musculoskeletal pain. This study investigates the relationship between patient demographics, co-morbidities, health behaviours and difficulty in accessing GP services in the United Kingdom. Significant associations were explored between age, co-morbidities and ease of securing GP appointments. This analysis provides insights into the barriers patients face and suggests targeted interventions for improving access to primary care. A cross-sectional study was conducted using survey data from participants of various ages, ethnicities and socioeconomic statuses with either localised or generalised musculoskeletal pain. Relationships between key variables, such as age, co-morbidities and difficulty in accessing GP services, were examined using chi-square tests (for nominal variables) and Kruskal-Wallis tests (for nominal and ordinal variables). A total of 503 respondents participated in the online questionnaire. In all, 66% of the respondents were female. The majority of participants were Caucasian (69%), followed by South Asians (19%), with the remainder identifying as Black or of mixed ethnicity. Most respondents (62%) reported experiencing musculoskeletal pain for over 2years. Significant associations were found between the age of the participants and difficulty in accessing GP services (χ2(20)=39, p=0.006), co-morbidities and the impact of delayed GP reviews on patients' musculoskeletal pain (χ2(10)=31, p=0.001), employment status and alternative care choices (χ2(4)=10.99, p=0.027). These results highlight the multifaceted nature of healthcare access for patients of various ages with musculoskeletal pain. Age, co-morbidities and employment status significantly influence access to GP services. Future studies should explore additional systemic healthcare barriers and develop personalised interventions to improve access for high-risk populations.

Plucking Heartstrings: Guqin, Aesthetic Attunement, and TCM Music Therapy

In the Chinese cultural context, music is deeply intertwined with the human heart and plays a central role in both healing and governance. Guqin, an ancient Chinese zither, exemplifies holistic care throughout history, embodying heart-based empathy and resonance. This study draws on insights from traditional Chinese medicine (TCM), classic philosophy, literature, and aesthetics to trace a lineage of thinking that continues to inform contemporary music therapy. We examine the Chinese notion of xin/heart and the interdependent self, and how music facilitates individuals’ aesthetic attunement toward the natural and social orders. Our approach transcends limitations of Euro-American psychological paradigms centered on the psyche, by adopting a holistic perspective that emphasizes the interconnectedness of the heart, the body, and the cosmos. We argue for the necessity of moving beyond reductive biomedical treatment models to explore alternative ways of living and alternative care that highlight relational, moral, and aesthetic approaches to well-being.

Strategies to address common sleep disorders among middle-aged and older adults

Abstract Obstructive sleep apnea (OSA) is an underdiagnosed and prevalent condition in middle-aged and older adults, with a disproportionate burden of OSA in marginalized populations. Lack of appropriate and timely treatment puts many at risk of poor quality of life, comorbidity, motor vehicle crashes and increased health care utilization. Furthermore, social and environmental disparities were acknowledged as contributing to sleep health disparities, OSA health literacy and adherence to OSA treatment. This presentation will overview the social and environmental determinants of OSA prevalence and management. The presenter will also cover strategies to improve access and waiting time for OSA diagnosis and treatment in middle-aged and older adults, such as screening for OSA in general and marginalized populations, alternative at-home OSA detection solutions, involvement of alternative care providers in OSA care, alternative OSA targeted therapies, including accessible self-administered interventions, health equity interventions targeting OSA, and promotion of sleep-centered lifestyle approaches, including weight loss, diet and exercise.

What is Known About the Numbers, Experiences and Outcomes of Young People Transitioning from Out-of-home Care in Indonesia?

Young people transitioning from out-of-home care (OOHC), commonly known as care leavers, are widely recognised internationally as a vulnerable group often subject to disadvantage. Yet, most studies of their pathways and outcomes to date have been completed in affluent Global North countries, and there have been relatively few reports on their experiences in Global South locations where different political, legislative, cultural and religious contexts exist. The particular attention of this article is on the Republic of Indonesia. Previous literature regarding children and young people in OOHC in Indonesia highlighted the poor quality of care within OOHC institutions and their adverse experiences of institutionalisation. In recent years, the Government of Indonesia has encouraged deinstitutionalisation by preventing family separation, promoting family-based alternative care and only utilising residential care as a last resort for child care. Nevertheless, little scholarly attention and studies have been given to researching young people leaving OOHC, who are likely to have poor life outcomes. Utilising existing grey government and non-government literature and reports, this policy briefing critically examines what is known about the numbers, experiences and outcomes of young people transitioning from OOHC in Indonesia.

Childhood Adversity and Life Satisfaction in Adults with Alternative Care Experience in 12 Low- and Middle-Income Nations: The Mediating Roles of Individual and Relational Protective Factors and Resilience

Adults with care experience have elevated rates of adverse childhood experiences (ACEs) and a greater likelihood of poor outcomes. Some research has examined how protective factors and resilience impact outcomes among care leavers, but few studies include those from low- and middle-income countries (LMICs). Further, little work has examined the interactive impact of protective factors and resilience in this population. We investigated (a) the prevalence of ACEs among care leavers from LMICs, the mediating roles of (b) resilience and (c) individual and relational protective factors on the relationship between ACEs and life satisfaction, and (d) whether mediation was occurring both in parallel and sequentially. Five hundred forty-two care leavers from twelve LMICs completed an online survey. Participants completed the Brief Resilience Scale, ACEs Questionnaire, and open-ended questions regarding care experiences. Open-ended questions were coded for protective factors. There was a high prevalence of ACEs among care leavers. The relationship between ACEs and life satisfaction was partially mediated by resilience. Individual and relational protective factors partially mediated the relationship between ACEs and life satisfaction. Finally, resilience and protective factors partially mediated the relationship between ACEs and life satisfaction in both parallel and sequential mediation among care leavers from LMICs. Protective factors operate interactively to influence resilience, increasing life satisfaction among care leavers from LMICs.

Improving Post-discharge Weight Gain Among Neonates received Kangaroo Mother Care: Two Years Experience of a Tertiary Care Hospital in Dhaka, Bangladesh

Background: “Kangaroo Mother Care” is an effective alternative care strategy for preterm and low birth weight babies. It also causes substantial reduction of neonatal mortality due to hypothermia. Objective: To observe the status of ongoing kangaroo mother care service in a tertiary care hospital and its outcome. Material and method: This retrospective study was carried out over the period of 1st July 2020 to 30th June 2022. Newborns who received kangaroo mother care in neonatal intensive care unit and postnatal ward of Bangabandhu Sheikh Mujib Medical University, Dhaka during the study period, were enrolled in this study. Results: A total of 384 (97% of eligible candidates) newborn received kangaroo mother care. Kangaroo mother care was provided both in Neonatal intensive care unit (86% of total admission) and also in the postnatal ward. Mean gestational age was 32.02+2.85 weeks (28 weeks-41 weeks) and mean weight of starting KMC was 1367.48 g (730 g – 1970 g). Average age of initiating KMC was 6 days (ranging from 1 to 13 days of age). Mean duration of providing KMC was 6 hours and 50 minutes. More than two third (74.4%) patients came for follow up. During each follow up, an increasing trend was observed regarding weight gain and mean weight gain was 15.9+1.2 g/ kg/day. Conclusion: Kangaroo mother care was provided to most of the eligible patients and persistent weight gain was observed among all KMC candidates after discharge.

Codesigning rights-based recordkeeping for childhood out-of-home care

ABSTRACT Decades of inquires in Australia and internationally into child welfare and protection systems have highlighted the importance of quality recordkeeping to the lifelong identity, memory and accountability needs for those who experience Alternative Care. Having learnt about the devastating impacts of poor recordkeeping and challenges in accessing records of childhood Care experiences, it is clear that transformative approaches are needed to tackle what Australia’s Royal Commission into Institutional Responses to Childhood Sexual Abuse in December 2017 has labelled a ‘systemic and enduring’ problem. In this paper, we report on our involvement in a co-design team of recordkeeping researchers, Care leaver advocates, and digital technologists working together to develop a deep understanding of Care recordkeeping needs and realise them in the functionality of a digital prototype. Developed as a design provocation – a blueprint for participatory recordkeeping infrastructure – we will explain how it enables those currently cast as the client of services and ‘subject’ of records, to participate in their Care recordkeeping on equitable terms. We will discuss how having knowledge of, and appropriate say over, who has access to personal information and records can be re-imagined through digital technologies in support of lifelong rights to identity, privacy, autonomy and accountability.

Institutionalization Of Children And Their Overall Development

The ideal environment for children's physical, psychological, and emotional development is within a family. All children should live in supportive, protective, and caring settings that enables them to achieve their full potential. Those with inadequate or no parental care are especially at risk of missing out on such nurturing environments. Many children in India lack a stable home and family. These include abandoned, surrendered, and orphaned children, as well as destitute children with families. These children are particularly vulnerable in terms of their right to survival, development, and protection. The State is accountable for protecting the rights pertaining to these children and ensuring appropriate alternative care through its competent authorities, such as nongovernmental organizations and civil society organizations. The Government also enacted the Juvenile Justice (Care and Protection of Children) Act 2015, which serves as the major legislative framework for child protection in India, ensuring the security, protection, education, welfare, and development of children in need. The paper attempts to explore the institutionalization of children, the shortcomings of such a process, and the felt needs of the children. It focuses on the concerns of institutionalization and the overall development of children, access to their rights, welfare provisions, and relevant legislations. It also looks at adoption as an alternative to institutionalization. The paper thus examines child care institutions from the perspective of the child and argues that institutional care should be the last resort. It also discusses contemporary social work and advocates for alternative care, along with comprehensive welfare measures to guarantee the protection and overall development of children in need

Variation in attendance at emergency departments in England across local areas: A system under unequal pressure

BackgroundCrowding in Accident and Emergency Departments (AEDs) and long waiting times are critical issues contributing to adverse patient outcomes and system inefficiencies. These challenges are exacerbated by varying levels of AED attendance across different local areas, which may reflect underlying disparities in primary care provision and population characteristics. MethodWe used regression analysis to determine how much variation across local areas in England of attendance at emergency departments remained after controlling for population risk factors and alternative urgent care provision. FindingsThere is substantial residual variation of the order of 3 to 1 (highest to lowest) in per person attendance rate across different areas. This is not related to in-hospital capacity as proxied by the per person number of hospital emergency doctors in an area. ConclusionSome areas in England have emergency departments that are under much greater pressure than others, and this cannot be explained in terms of their population characteristics or the availability of alternative treatment options. It is imperative to better understand the drivers of this variation so that effective interventions to address utilisation can be designed.

The Social Reality of Meaning Making: The Dichotomy in the Illness Narratives of Women With Breast Cancer and Biomedical Practitioners in Nigeria.

Despite the increasing burden of breast cancer in the developing world, there is a misunderstanding of the complex and multifaceted relationship between culture and cancer, particularly breast cancer. Hence, a dichotomy of illness narratives exists due to differential meaning making concerning breast cancer. While clinicians always recommend biomedical treatment, women with breast cancer often seek alternative treatment pathways. To explore the experiences of women with breast cancer and clinicians in Nigeria on the dichotomy in the illness narratives. This qualitative study used in-depth interviews and focus group discussion to explore the experiences of 22 women with breast cancer and 7 clinicians in Nigeria on the dichotomy in the illness narratives using grounded theory method analysis. This study revealed that many women living with breast cancer (WLBC) hold health beliefs that are contradictory to the biomedical norm. They mostly sought treatment based on the perceived aetiology of breast cancer. The treatment pathway follows faith and traditional healing as alternatives or sometimes in combination with biomedicine. WLBC reported a constant fear of biomedical treatment, perceived to be harmful to women's sexuality, fertility and body image. Hence, after perceived treatment failure from alternative care, biomedical care becomes the last resort, usually at an advanced stage of breast cancer, often responsible for poor prognosis. There is a dichotomy of illness construction between sufferers and health practitioners. To guide women with breast cancer on the path of care, modern care practitioners should consider some cultural norms and practices without compromising professional ethos.

“Pathfinder Filled The Gap And Linked In With The Necessary Services” Service User Perceptions Of The Pathfinder Service

Abstract Background Pathfinder is a service designed to keep older adults who phone 999 at home by utilising alternative care pathways, when it is safe to do so. Pathfinder responds to adults aged 65 and older who present with low acuity complaints. The service is delivered by Occupational Therapists, Physiotherapists and Advanced Paramedics and is embedded between acute and community care. The aim of this study is to capture how the service user found their interaction with this novel service. Methods As part of routine service evaluation, semi-structured brief telephone interviews with closed and open-ended questions were completed with a number of service users (the patient or their primary care giver). Interviews were completed at least one week after their discharge from the service, by a member of the team who had not been involved in their care. Interviews were then analysed using Microsoft Excel® for closed ended questions and thematic analysis for open ended questions. Results One hundred service users were contacted, of which 76 completed the brief telephone interviews. 99% of respondents felt Pathfinder treated them with respect and dignity, 100% felt Pathfinder communicated clearly and 97% rated the service as excellent. Five key themes were identified from open-ended questions (1) the prompt arrival of care, (2) the thorough examination and reassurance provided, (3) the benefit of follow-up after the initial 999 call, (4) the domino effect of onward referrals and (5) the holistic approach to care given. Conclusion There was universal positive feedback for the Pathfinder service reported by both older adults who engaged with the service and their primary care givers. Key elements of the service delivery were complimented including the assessment, the follow up service provided and the onward referral to acute and community services.