Care Arrangements Research Articles

Refugee Policy in Romania

Romania is currently facing a high influx in the number of Asylum seekers and refugees, but significantly minimized Knowledge available on the policy framework and care arrangements for the Refugees in Romania over the integration policy confined the people displayed the need for international protection. This particular scientific paper addresses the Romanian Refugee policy while illustrating the gaps and cores of this policy in the political dimension utilizing scholarly literature

Grandparenting left-behind children in Javanese Migrant-sending villages: Trigenerational care circuits and the negotiation of care

Parental labour migration requires recalibrations of care arrangements within the left-behind family. Existing studies of left-behind families, however, have largely concentrated on parental rather than grandparental caregiving of grandchildren. We argue that grandparents are pivotal to care work and changing family formations within migrant-sending villages. Grandparents provide supplementary care, substitutive care and even reconstitutive care, depending on the migration and marital status of the parents. The paper emphasizes the often unilateral care-contracts between grandparents and migrant parents, drawing on material primarily from the qualitative interviews of grandparent carers of left-behind children, and the grandchildren themselves. By considering a variety of family contexts in flux as a result of parental migration (mother, father or both parents) and marital dissolution amidst migration, we examine family situations holistically by taking into account the different modes of care provided by grandparents (occasionally in tandem with aunts) within changing care contexts.

Siblings' and parents' outlook for the prospective care for a family member with PIMD

AbstractObjectiveThis study aimed to explore the approaches adopted by the parents and typically developing siblings as to the prospective care and support for a family member with profound intellectual and multiple disabilities (PIMD).BackgroundWith an ever‐extending life span of persons with PIMD, it has become necessary for their parents to make arrangements for prospective care in which siblings may play an important role.MethodThe study was carried out by means of semistructured interviews held with parents and siblings of individuals with PIMD. The method used for analysis consisted in open and axial coding. Grounded theory methodology procedures served as the theoretical framework.ResultsParents commonly thought a future caregiving role would be an unfair burden to the typically developing siblings, who, in contrast, welcomed such a commitment.ConclusionsParents should not worry about the prospective care for their offspring with a disability given by their typically developing siblings. However, they should attend to the quality of communication, resolving discrepancies in the family members' perspectives on caregiving in the future.ImplicationsThese findings might offer insight for the parents and siblings of persons with PIMD as well as for social welfare institutions, social workers, and other professionals who work with children and their parents.

Contact with parents from childhood to adulthood – a longitudinal study of children in kinship care and non-kinship care

ABSTRACT Previous research on parental contact for children in foster care shows that contact frequency is significantly related to parent’s gender and placement type. Yet very few studies have explored the impact of gender and type of placement on parental contact over time. Based on longitudinal quantitative data from kinship care and non-kinship care placements in Norway, we analyse contact between children and their birth parents at three timepoints: childhood, adolescence, and adulthood. The study shows different contact patterns for children’s contact with mothers and fathers. For most of the children, the possibility of contact with the mother was established from the first timepoint and contact occurred rather frequently throughout childhood, adolescence, and adulthood. Regular contact between fathers and children in childhood, on the other hand, was less common, and this could develop in different directions: either towards children coming into contact with their father later in life or not at all. From a longitudinal perspective, we can say that the most significant changes evolved around children’s contact with their fathers, while contact with mothers was more stable.

Deprivation of liberty and children with complex needs: a new specialist court.

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the role of the National Deprivation of Liberty Court in authorising care arrangements for children that amount to a deprivation of liberty.

Telemedicine in healthcare access during the covid-19 pandemic: a scoping review.

Mapping the role of telemedicine in the health access of patients with chronic diseases in continuous care actions (except for covid-19) during the pandemic. This is a scoping review, with an adapted version of the Prisma-Scr methodology and using the Population (patients with chronic diseases), Concept (telemedicine as a health access tool) and Context (covid-19 pandemic) strategy. We searched through the following databases: PubMed, Scopus, Embase, Web of Science, Lilacs and SciELO, resulting in 18 articles at the end of the review. We used the technological, sociocultural and assistance analysis dimensions. Eighty-eight percent of the analyzed papers posited that telemedicine use to provide care increased during the pandemic. We identified that this use was positively related to the reduction of complications and the absence of physical displacement for care, expanding it to rural areas. Important barriers were presented, most importantly the digital exclusion, language sociocultural barriers, and inaccessibility to technological instruments for disabled people. Innovation in care arrangements calls attention to how living labor is important to produce healthcare, using various technologies, and reveals tensions caused by the forces acting on healthcare micro politics. We conclude that, despite important barriers, telemedicine contributed to the care of chronic patients during the covid-19 pandemic.

On Causal Inference and the Limits of Disproportionality as a Construct: The Case of Foster Care Placement

The unwarranted disparities in our foster care system are the result of historical and structural causes. If we hope to correct these disparities by addressing their root causes, we must measure them carefully. In this article, I ask whether our usual measures of Black child/White child placement differences tell us what we need to know to act on those disparities with greater certainty. I specifically examine the limits of disproportionality as a measure. As a way to observe over- and underrepresentation, disproportionality is useful. When the discussion turns to the causes of differential treatment of Black children (or any other children) within the child protection system, there are more useful ways to measure those differences. I demonstrate this point in technical terms, and then I suggest alternative approaches to the measurement problems. Other approaches, I argue, offer a more vivid picture of the problem social workers are trying to solve.

Contact with mothers for children in out-of-home-care: Group-based trajectory modelling from the Pathways of Care Longitudinal Study (POCLS)

BackgroundGood quality contact with birth parents is considered important to successful out-of-home care (OOHC) placements. ObjectiveThere is, however, an absence of empirical evidence about contact needs of children in the OOHC system and how these needs change over time. Participants and settingThe current analysis analyzed four waves of data from the Pathways of Care Longitudinal Study in Australia relating to 1507 children on yearly frequency of contact with mothers, relationship quality with mothers, and the extent that contact met the needs of the child. MethodsGroup-based trajectory modelling was used to examine in what ways frequency of contact, child-mother relationships and child's needs for maintaining family contact were associated over time. ResultsThe analysis showed a positive association between these three outcomes that also held true as the children aged, with five distinct patterns: (1) low frequency and poor relationship (low poor) (14.5 % of the sample); (2) moderate frequency and poor relationship (moderate poor) (30.3 %); (3) increasing frequency and improving relationship (improving) (19.8 %); (4) declining frequency and declining relationship (declining) (19.5 %); and (5) high frequency, good relationship (high good) (15.9 %). Care type, child demographics, child socioemotional wellbeing and unsupervised contact arrangements were significantly associated with trajectory group membership. ConclusionsThese results can be used to inform policy and practice around contact and to better match the heterogenous contact needs for children in OOHC.

Effectiveness of group intervention in improving kinship care families’ outcomes: A systematic review of group interventions aimed at kinship caregivers and youth in kinship care

BackgroundDespite the specific needs and challenges that kinship caregivers fostering adolescents face, they still receive less training, monitoring, and social support than non-kinship foster caregivers. Although the effectiveness of interventions and programmes targeting kinship care stakeholders has been previously assessed, a systematic review analysing the effectiveness of group interventions in kinship care outcomes for both kinship caregivers and adolescents in their care is still missing. ObjectivesThis systematic review aims to explore the impact of the group intervention format and to identify which components of this format positively impact kinship care placements that involve youth. MethodsWe identified 13 studies through six databases. The extracted information was displayed through the following categories: location, target of intervention, research design, setting/format of intervention, group intervention description, sample, statistical tests and methods, outcomes, and key findings. ResultsResults revealed that the assessed group interventions aimed to improve parenting skills and social support in kinship caregivers fostering youth. Improvements in both outcomes are likely common in group interventions focused on training parenting skills, with a group size of fewer than ten participants, approximately six to ten group sessions (90 min/session) conducted once a week and implemented interactive activities. Improvements in social support are more likely to be observed for interventions that combined group format and case management. Group intervention benefits relationships with peers, and permanency of the placement in kin youth. DiscussionFindings indicate that more evidence-based group interventions aimed at kinship caregivers fostering youth in kinship care should be designed and assessed to address their specific needs adequately. We have also discussed future research directions and their practicality.

Comparison of the effectiveness of exclusively facilitated clinical teaching as an alternative to traditional practice-based primary care placements

ABSTRACT Introduction COVID-19 presented major challenges to undergraduate GP placement capacity and there was an increased reliance on clinical training using facilitated simulation. The authors present a novel comparison of the effectiveness and cost-effectiveness of delivering a one-week primary care course using entirely GP-facilitated clinical teaching outside the GP setting against traditional practice-based GP clinical education. Methods A one-week GP placement was redeveloped from a traditional teaching model (TT-M) to an exclusively facilitated teaching model (FT-M) delivered outside the GP practice setting, using principles of blended learning, flipped classroom methods, e-learning and simulation. Both teaching models, delivered in different locations during 2022 to pre-clinical students, were evaluated using student feedback surveys for attainment of learning outcomes and course satisfaction. Results The students reported their consultation skills and clinical knowledge (amalgamated mean score 4.36 for FT-M versus 4.63 for TT-M; P = 0.05), as well as preparation for the clinical phases (mean scores 4.35 for FT-M versus 4.41 for TT-M; P = 0.68), were well developed and similar for both courses. Students reported similar enjoyment across both teaching models (FT-M mean score 4.31 versus 4.41 for TT-M; P = 0.49). The costs for delivering teaching per 4-h session for 100 students were £1,379 and £5,551 for FT-M and TT-M, respectively. Conclusion Delivery of a one-week primary care attachment to third year medical students using an FT-M was similarly effective and more cost effective than delivering it by a TT-M. FT-M potentially offers an important adjunct to clinical learning and resilience to capacity challenges for GP placements.

Area‐deprivation, social care spending and the rates of children in care proceedings in local authorities in England

AbstractThis paper examined relationships between area‐level deprivation, local authorities' social care expenditure and the rates of children entering care proceedings in England using a novel data linkage of de‐identified records provided by the Children and Family Court Advisory Service (Cafcass). Using structural equation modelling, the authors found strong positive relationships between socioeconomic area deprivation and high rates of children undergoing care proceedings in England between 2015 and 2019. Preventative social care expenditure is associated with lower child rates when adjusting for deprivation. Our findings suggest that deprived and underfunded local authorities respond to an increased need by prioritizing care arrangements.

More long‐term care for better healthcare and vice versa: investigating the mortality effects of interactions between these public sectors

AbstractPublic healthcare (HC) and long‐term care (LTC) sectors coexist in several OECD countries. Economic interactions between these two sectors have been found to occur even in the absence of formal integrated care arrangements. We investigate whether and how interactions between the HC and LTC sectors impact mortality. We analyse data on English local authorities in 2014–15 and employ a sequence of cross‐sectional econometric specifications based on instrumental variables to identify the effect that LTC expenditure has on mortality through its interactions with HC services, and vice versa. Our findings suggest that any effect of LTC expenditure on mortality is likely to run through the HC sector by allowing the latter to reallocate resources from less to more effective services. A 10 per cent increase in LTC expenditure per user can indirectly save, on average, about three lives per million individuals. In addition, on top of the known HC direct mortality effects, we find that investing an extra £42 million in the HC sector – equivalent to a 10 per cent increase in HC expenditure per capita for the average local authority – can decrease the use of LTC services, producing around £7.8 million of savings. These can generate mortality effects if invested in services having an impact on mortality.

Teaching Neuro Images : Neurodegeneration with brain iron accumulation in aceruloplasminemia

A 55-year-old African Canadian man with insulin-dependent diabetes mellitus and alcohol abuse presented with diabetic ketoacidosis. Progressive cognitive decline over the previous 5 years resulted in long-term care placement. Aside from pigmentary retinopathy, general examination was unremarkable. MRI demonstrated iron accumulation in the brain (figure 1) and liver (figure 2A). Ceruloplasmin, a ferroxidase enzyme important in iron homeostasis, was undetectable and associated with low serum iron, low serum copper, and 10-fold increase in serum ferritin. Liver biopsy confirmed increased hepatocyte iron storage (figure 2B). Aceruloplasminemia was diagnosed.1,2 Iron chelation was not administered given advanced dementia at presentation.

Agencements de soins et rationalités multiples dans un service d’hémato-oncologie pédiatrique au Cameroun

Agencements de soins et rationalités multiples dans un service d’hémato-oncologie pédiatrique au Cameroun

Lifetime rates and types of subsequent child protection system contact following a first report of neglect: An age-stratified analysis.

An estimated 1 in 3 U.S. children will be the subject of a child protective services (CPS) investigation during their lifetime, typically for allegations of neglect. Whether and how an initial report of neglect is addressed may place children on divergent trajectories for safety and stability throughout childhood. The purpose of this study is to track subsequent CPS contact among children born in California in 2000 who were first investigated by CPS for neglect allegations alone (no co-occurring abuse) and not permanently separated from their families of origin (i.e., not removed or reunified if removed). We estimated the rates of subsequent CPS referrals, substantiated maltreatment, placement in foster care, and allegations of physical and sexual abuse by age 18. We assessed how rates of subsequent contact varied by initial CPS response and age at first investigation. Supplemental analyses disaggregated data by race and ethnicity. Results indicate that 64% of children initially investigated for neglect alone were re-referred to CPS by age 18 and 16% experienced a subsequent removal; however, these estimates varied greatly by age. Four out of five (79% to 83%) of children initially investigated as infants had one or more subsequent CPS referrals during childhood. Children were not only re-referred for allegations of neglect; more than half of children re-referred were reported for allegations of physical or sexual abuse, indicating that abuse risk was either missed during the initial CPS investigation or escalated afterward. The failure to address maltreatment risks when children first present to the system is a complex problem with no easy solution. Our findings document that a majority of children initially referred for neglect experience future CPS involvement, often for allegations of physical or sexual abuse.

Placement Matching of Children and Young People within Out-of-Home Residential Care: A Qualitative Analysis

Residential care for children and young people is typically regarded as the least preferred option in out-of-home care by child welfare and protection practitioners. Increasingly, residential care is only used to place young people after multiple unsuccessful placements in kinship or foster care. Consequently, these young people often come into residential care with complex needs and entrenched emotional and behavioural difficulties. Coplacement of these young people in residential care has raised significant and persistent concern of peer victimisation while in residential care. Improved matching of peers within residential care may enhance safety and stability, a proposal for which young people themselves have expressed support. However, the matching of young people in residential care has received little attention in research. This article reports the qualitative findings of a multiinformant study, drawing on the first-hand experiences of 34 participants comprising eight young people and 26 practitioners in residential care, to identify the considerations they perceived as important when matching young people in residential care. Framework analysis of young people's and practitioners’ perspectives identified three matching strategies that may more effectively address the concern of peer victimisation in residential care including (1) balancing risks and strengths; (2) steering into collective duty of care; and (3) involving young people in planning and transition. Implications of the findings directly point to the need to prioritise young people’s rights to protection and participation, and to provide independent oversight to assist residential care organisations and the broader child welfare system to navigate the complexity in the practice of matching young people in residential care.

From prediction to decision: Optimizing long‐term care placements among older delayed discharge patients

This study examines long‐term care (LTC) discharge planning among older delayed discharge patients. While awaiting placements in alternate care such as LTC, these patients occupy hospital beds despite not requiring an intensive level of care. This study proposes a novel discharge decision model based on the Markov decision process (MDP) framework, which incorporates predictions regarding the patients' health trajectory and the associated hospital costs. Our machine learning (ML)‐based predictive analytics allow for considering heterogeneous health transitions, hence personalized decision making, leading to valuable information for reducing hospital costs. We also develop data‐driven cost functions using patient characteristics to estimate the person‐level costs associated with the decisions in the optimization model, that is, whether or not to discharge a patient to LTC. The data analyses and cost estimations are based on large historical data collected over 13 years in Ontario, Canada. To solve the resulting high‐dimensional MDP models, we develop an index policy, where each patient's index value is calculated using their health complexity (comorbidity), sex, age, and acute length of stay in the hospital. Using extensive numerical experiments, we illustrate the superior performance of the proposed index policy against some benchmarking policies and demonstrate the significance of predictive information in optimizing discharge decisions. Our results also indicate that the value of predictive information increases with LTC bed availability and decreases with hospital capacity. We also demonstrate that with the anticipated exacerbating mismatch between supply and demand, targeted prediction‐driven discharge policies, such as the proposed index policy, become even more critical.

Changes in parents' mental health related to child out-of-home care placements: A Swedish national register study

BackgroundLiterature on outcomes of children in out-of-home care (OHC) is extensive. However, less is known regarding associations of such placements with parental mental health disorders (MHD). ObjectiveThis study investigated changes in hospitalization rates due to MHD among parents, four years before and after placement of their child in OHC. Participants and settingWe used data on 4067 members (Generation 1) of the RELINK53 cohort (individuals born and living in Sweden in 1953) and their 5373 children (Generation 2) in OHC. MethodsUsing random effects regression models, associations between OHC and MHD were examined separately for fathers and mothers. Nested models were tested exploring associations with parent and child/placement-related factors. Marginal effects were computed to assess mean rates of hospitalization annually. ResultsOverall, mothers had higher mean hospitalization rates than fathers. Compared to the year of placement, hospitalization rates were significantly lower in the four years before placement for mothers (9.9 %, 9.5 %, 10.5 %, 12.1 %, respectively) and fathers (5.9 %, 7.6 %, 8 %, 9.8 %, respectively). Mothers showed highest hospitalization rates at the year of placement (26.6 %), while fathers, one year after placement (13.4 %). Hospitalization rates declined significantly directly after placement among mothers, but an unclear and non-significant pattern of results was found among fathers. ConclusionsMost parents have higher hospitalization rates at and directly after placement. Potential hypotheses underlying these findings are discussed, including psychosocial gender differences and opportunities to seek care as means of reunification. There is an urgency to develop strategies to better support these parents throughout the process.

Care arrangements of older persons in rural Indonesia: a study of six villages

ABSTRACT This study explores the provision of care for older persons in rural areas of ageing Indonesia. Using data from Ageing in Rural Indonesian Study, we examine who needs care, who provides care, and how care operates across socio-demographic settings. We found that one contributing factor to gender inequality in old age is the disproportionate amount of unpaid care that older women provide to their families. Older women are often both care recipients and providers. Kinship systems play an important role in determining care responsibilities. Male family members have prominent caring roles in patrilineal villages, but limited roles in villages with bilateral kinship systems. Care operates through a tiered system of family-based habitual care, small-scale paid care, community care, and institutional care. This study also highlights the significant role of the community in providing care through traditional forms of social support in the absence of government social protection in rural communities.

Managing total knee replacement under value-based payments.

To evaluate opportunity gaps and set outcome goals in knee replacement (KR) between a primary care group taking financial risk for managing its patients and 6 fee-for-service (FFS) orthopedic groups that serve their patients. The opportunity gap analysis was a cross-sectional evaluation of the outcomes of interest on a risk-adjusted basis using orthopedic groups, the primary care group's patients, and regional comparisons. The impact evaluation was a historical cohort comparison tracking outcomes of interest over the time frame of the intervention. Using risk-adjusted Medicare data, we defined opportunity gaps in the following outcomes: density of KR surgery, site of KR surgery, postacute care placement, and complications. Opportunity gap analysis demonstrated the following variation on a regional basis: a 2-fold difference in density of KR, a 3-fold difference in outpatient surgery, and a 2.5-fold difference in institutional postacute care placement. In the impact evaluation comparing 2019 with 2021, the primary care group's patients had reduced density of KR surgeries from 15.5 per 1000 to 13.0 per 1000, an increase in outpatient surgery from 31.0% to 81.6%, and a reduction in institutional postacute care utilization from 16.0% to 6.1%. Less pronounced trends were seen in the region for all Medicare FFS patients. These results were achieved with stable complication rates, which had an observed/expected ratio of 0.61 in 2019 and 0.63 in 2021. We achieved alignment of incentives through use of performance information with specific goals and promise of referrals to value-based partners. This approach resulted in improved value to patients with no evidence of harm and is translatable to other specialty care and markets.