Community Care Workers Research Articles

Using Generational Intelligence to Examine Community Care Work between Younger and Older Adults

Exploring the factors that contribute to sustainable forms of an intergenerational relationship is becoming an important conceptual and practical challenge, not least because of the growing need for an aged care workforce that is both motivated and suitably trained. Generational intelligence is a means of examining interaction between younger and older people which has been applied to community care settings. Dimensions of generational intelligence include recognising and valuing generational differences, finding common ground, plus negotiating social and practical outcomes from the situation. A case study plus a series of qualitative interviews are used to examine the value of this approach both as a means of exploring the processes involved in generational exchange and in providing recommendations for work preparation and training. It is suggested that intergenerational relations have been a missing factor in the understanding of sustainable care and that in future, service delivery should not simply be analysed as comprising professional and lay perspectives but also as containing generationally distinctive perspectives that require negotiation.

The impact and cost of the HIV/AIDS investment framework for adolescents.

In 2005, the resources needed to support orphans and vulnerable children in sub-Saharan Africa were estimated at US$ 1.1-4.1 billion. Approaches to support vulnerable children have changed considerably since then. This study updates previous estimates by including new types of support and information on support costs. We considered 16 types of support categorized as economic strengthening, education support, social care and community outreach, and program support. The estimates combine the number of children in need of each intervention with unit costs derived from the literature and coverage goals based on current coverage and feasible future improvements. The number of children affected by AIDS in low- and middle-income countries varies from 58 million to 315 million depending on the definition of need. The resources required to provide support to children living in poor households will grow from US$ 4.2 billion in 2012 to US$ 5-8 billion by 2020. Almost two-thirds of these resources will be needed for Sub-Saharan Africa. The largest needs are for cash transfers, community care workers, early childhood development, block grants for education, M&E monitoring and evaluation, and direct material support. The results show that we can significantly improve the coverage of services for vulnerable children with only modest increases in resources. This results from stable or declining numbers of orphans and children living with HIV plus economic growth that is moving more households out of poverty. The results also reflect an important shift toward providing support to strengthen families and communities that care for children rather than direct material support. More resources are required to support children affected by AIDS, but new approaches to provide that support will be cost effective and have broad social and economic benefits.

A randomized clinical trial of an intervention to promote resilience in young children of HIV-positive mothers in South Africa.

The objective of this study is to assess the efficacy of an intervention designed to promote resilience in young children living with their HIV-positive mothers. HIV-positive women attending clinics in Tshwane, South Africa, and their children, aged 6-10 years, were randomized to the intervention (I) or standard care (S). The intervention consisted of 24 weekly group sessions led by community care workers. Mothers and children were in separate groups for 14 sessions, followed by 10 interactive sessions. The primary focus was on parent-child communication and parenting. Assessments were completed by mothers and children at baseline and 6, 12 and 18 months. Repeated mixed linear analyses were used to assess change over time. Of 390 mother-child pairs, 84.6% (I: 161 and S: 169) completed at least two interviews and were included in the analyses. Children's mean age was 8.4 years and 42% of mothers had been ill in the prior 3 months. Attendance in groups was variable: only 45.7% attended more than 16 sessions. Intervention mothers reported significant improvements in children's externalizing behaviours (ß = -2.8, P = 0.002), communication (ß = 4.3, P = 0.025) and daily living skills (ß = 5.9, P = 0.024), although improvement in internalizing behaviours and socialization was not significant (P = 0.061 and 0.052, respectively). Intervention children reported a temporary increase in anxiety but did not report differences in depression or emotional intelligence. This is the first study demonstrating benefits of an intervention designed to promote resilience among young children of HIV-positive mothers. The intervention was specifically designed for an African context and has the potential to benefit large numbers of children, if it can be widely implemented.

Community care workers, poor referral networks and consumption of personal resources in rural South Africa.

Although home-based care (HBC) programs are widely implemented throughout Africa, their success depends on the existence of an enabling environment, including a referral system and supply of essential commodities. The objective of this study was to explore the current state of client referral patterns and practices by community care workers (CCWs), in an evolving environment of one rural South African sub-district. Using a participant triangulation approach, in-depth qualitative interviews were conducted with 17 CCWs, 32 HBC clients and 32 primary caregivers (PCGs). An open-ended interview guide was used for data collection. Participants were selected from comprehensive lists of CCWs and their clients, using a diversified criterion-based sampling method. Three independent researchers coded three sets of data – CCWs, Clients and PCGs, for referral patterns and practices of CCWs. Referrals from clinics and hospitals to HBC occurred infrequently, as only eight (25%) of the 32 clients interviewed were formally referred. Community care workers showed high levels of commitment and personal investment in supporting their clients to use the formal health care system. They went to the extent of using their own personal resources. Seven CCWs used their own money to ensure client access to clinics, and eight gave their own food to ensure treatment adherence. Community care workers are essential in linking clients to clinics and hospitals and to promote the appropriate use of medical services, although this effort frequently necessitated consumption of their own personal resources. Therefore, risk protection strategies are urgently needed so as to ensure sustainability of the current work performed by HBC organizations and the CCW volunteers.

Transactional Analysis Transforms Community Care Workers in South Africa

This article describes the use of transactional analysis in psychosocial support programs for community care workers in South Africa. The authors discuss the context and development of this work as well as the modifications made to transactional analysis models to ensure their relevance to the communities being served. The theory of the Cultural Parent and cultural shadow (Drego, 1996) is one aspect that informs the methodology of the wellness programs. The work is also supported by the use of Capacitar techniques (Cane, 2000) and creative activities. The relevance of various learning philosophies (Newton, 2003) to support and influence the transformative elements of the work is detailed, and the social impact of this work with grassroots community care workers is discussed.

Personal care workers in Australian aged care: retention and turnover intentions

This study examined factors influencing personal care workers' intentions to stay or leave Australian aged care employment - especially for older workers. Retention of personal care workers is particularly important in aged care as they provide the majority of the direct care via community aged care or long-term aged care environments. However, there is limited research on what drives their turnover and retention. A survey was conducted during 2012 collecting 206 responses from workers within community and long-term aged care in four organisations in Australia. Perceived supervisor support, on-the-job embeddedness and area of employment were identified as predictors of both intention to stay and to leave, although the relationship strength differed. Community care workers were more likely to stay and reported more supervisor support than long-term care workers. Unexpectedly, age and health status were not predictors of staying or leaving. While there are similarities between retention and turnover motivators, there are also differences. Within a global context of health worker shortages, such new knowledge is keenly sought to enhance organisational effectiveness and sustain the provision of quality aged care. Retention strategies for older workers should involve increasing supervisor support, and seeking to embed workers more fully within their organisation.

Community-based intervention to enhance provision of integrated TB-HIV and PMTCT services in South Africa

To conduct an impact assessment of an intervention to enhance the provision of community-based integrated services for tuberculosis (TB), human immunodeficiency virus (HIV) and prevention of mother-to-child transmission (PMTCT). The intervention consisted of a combination of training of community care workers (CCWs), structural adjustments, harmonisation of scope of practice and stipend of CCWs and enhanced supervision of CCWs to provide comprehensive TB-HIV/PMTCT services in a rural South African district. A before and after study design was used with a household survey to assess the operational effectiveness of the intervention. Six clusters were randomised into intervention and control arms. Quantitative data were analysed using logistic regression, adjusting for cluster design. Logistic regression analyses of the survey data show that CCWs from the intervention arm performed better in the provision of TB-HIV/PMTCT services, such as screening for TB and sexually transmitted infections, adherence to anti-tuberculosis treatment and antiretroviral therapy and counselling on infant feeding compared to the control CCWs (P < 0.05). However, intervention CCWs performed worse in the integrated management of childhood illnesses education and social welfare referrals (P < 0.05). The uptake of HIV testing increased significantly in the intervention arm, from 55% to 78% (P < 0.001). The intervention was effective in enhancing the provision of community-based TB-HIV and PMTCT services. However, attention to other primary health care services is required to ensure that all key services are provided.

Work Satisfaction and Intention to Leave Among Direct Care Workers in Community and Residential Aged Care in Australia

Turnover in the Australian aged-care workforce is lower than in the United States but is still of concern. This research examined the effects of worker satisfaction, worker characteristics, work conditions, and workplace environment on intention to leave, using data from a 2007 national census of the aged-care workforce. A probit model was used to estimate the probability of care workers leaving their jobs in the next 12 months. While workers were satisfied, overall, with their work, improving some components of satisfaction and converting casual contracts to permanent work would reduce intention to leave. To these ends, a shift in focus is required away from worker characteristics and the nature of care work to job conditions and organizational matters amenable to management and policy action.

Abstract

Enhancing the effectiveness of the community and aged care workforce to prevent malnutrition and functional decline is important in reducing hospital and aged care facility demand. To investigate the impact of nutrition-related interventions delivered to or by informal carers and non-clinical community care workers on malnutrition-related health outcomes of community-dwelling older adults (≥65years). Intervention studies were searched for using six electronic databases for English-language publications from January 1980 to 30 May 2012. Nine studies were eligible for inclusion. The strength and quality of the evidence was moderate (six studies with level II intervention evidence, five with positive quality). Types of interventions used were highly varied. The majority of interventions were delivered to informal carers (6 studies), with three of these studies also involving older adult care recipients. Five interventions were targeted at identifying, preventing and/or treating malnutrition specifically (two positive quality, three neutral quality, n=2368). As a result of these interventions, nutritional status improved or stabilized (two positive quality, two neutral quality, n=2333). No study reported an improvement in functional status but two successfully prevented further decline in their participants (two neutral quality, n=1097). Interventions targeted at identifying, preventing and/or treating malnutrition were able to improve or prevent decline in nutritional and functional status, without increasing informal carer burden. The findings of this review support the involvement of non-clinical community care workers and informal carers as part of the nutritional care team for community-dwelling older adults.

Community mental health care in South Asia

Community mental health care in South Asia

Are informal carers and community care workers effective in managing malnutrition in the older adult community? A systematic review of current evidence.

Enhancing the effectiveness of the community and aged care workforce to prevent malnutrition and functional decline is important in reducing hospital and aged care facility demand. To investigate the impact of nutrition-related interventions delivered to or by informal carers and non-clinical community care workers on malnutrition-related health outcomes of community-dwelling older adults (≥65 years). Intervention studies were searched for using six electronic databases for English-language publications from January 1980 to 30 May 2012. Nine studies were eligible for inclusion. The strength and quality of the evidence was moderate (six studies with level II intervention evidence, five with positive quality). Types of interventions used were highly varied. The majority of interventions were delivered to informal carers (6 studies), with three of these studies also involving older adult care recipients. Five interventions were targeted at identifying, preventing and/or treating malnutrition specifically (two positive quality, three neutral quality, n=2368). As a result of these interventions, nutritional status improved or stabilized (two positive quality, two neutral quality, n=2333). No study reported an improvement in functional status but two successfully prevented further decline in their participants (two neutral quality, n=1097). Interventions targeted at identifying, preventing and/or treating malnutrition were able to improve or prevent decline in nutritional and functional status, without increasing informal carer burden. The findings of this review support the involvement of non-clinical community care workers and informal carers as part of the nutritional care team for community-dwelling older adults.

Perspectives of the community-based dementia care workforce: “occupational communion” a key finding from the Work 4 Dementia Project

Community care workers' experience of delivering support to people with dementia is less researched than that of residential workers. The purpose of the study is to explore community-based dementia care workers' perspectives about their roles and the contextual variables that impact upon their work experiences. A qualitative design was employed. Twenty-five community dementia care workers (average age 53 years, majority female and employed casually) participated in standardized semi-structured interviews about their job roles, training, employer agenda, organizational support, and intention to stay. A deductive approach to Interpretive Phenomenological Analysis was adopted to identify key themes. Three themes highlighted workers' experiences. Occupational communion described strong attachment to clients and a desire for greater connection with colleagues. Job demands described the challenges of work, which varied with intensity. Job resources ranged from positive (strong organizational commitment) to negative (poor pay and conditions). Occupational communion was identified as a concept that exists at the interface between social and organization psychology that was perceived to be essential for adaptive coping. Identifying themes informed a conceptual model for designing intervention components aimed at improving workers' skills, capabilities, and employer supportive functions. Occupational communion may be particularly relevant for women's caring careers and future research is needed to explore the relevance of this concept for men. To determine reliable change associated with interventions that target occupational communion, further investigation is required in relation to measurement approaches.

Doing Care with Integrity and Emotional Sensibility—Reciprocal Encounters in Psychiatric Community Care of Older People with Mental Health Problems

The article focuses on the experiences of community care workers in the encounter with older persons suffering from mental health problems, such as mental illness and disability. The purpose is to describe and discuss opportunities for and challenges to reciprocal encounters with these older people in community care, based on statements from professionals interviewed. Structured conversations with five focus groups were organised, consisting of 26 participants, including nurses’ assistants, assistant nurses, nurses, social workers and occupational therapists. The participants in the focus groups highlight the essence of being involved and create space for a reflective attitude. Clinical implications will be presented as well.

Caregiver burden and related factors in caregivers of children with autism

Objective To investigate the level of caregiver burden of primary caregivers of children with autism, and explore the factors related to caregiver burden. Methods 177 caregivers of children with autism were tested with caregiver burden inventory(CBI)and childhood autism rating scale(CARS). A cross-sectional and multisite study design was used. Results The scores of caregiver burden was (57.50±14.91), and time-dependence burden and developmental burden were the most serious domains.Caregiver burden was affected by caregiver's age, caregiver's religious beliefs, caregiver's marital status, caregiver employment status and education degree and children's scores of CARS and degree of CARS(-0.151≤r≤0.282, P<0.05). Conclusion The data suggest that community care workers should pay attention to caregivers of children with autism and give them personalized health education and intervention according to the demographic characteristics of the caregivers and the severity of children disease. Key words: Autism; Children; Caregivers; Caregiver burden

Engagement of non-government organisations and community care workers in collaborative TB/HIV activities including prevention of mother to child transmission in South Africa: Opportunities and challenges

BackgroundThe implementation of collaborative TB/HIV activities may help to mitigate the impact of the dual epidemic on patients and communities. Such implementation requires integrated interventions across facilities and levels of government, and with communities. Engaging Community Care Workers (CCWs) in the delivery of integrated TB/HIV services may enhance universal coverage and treatment outcomes, and address human resource needs in sub-Saharan Africa.MethodsUsing pre-intervention research in Sisonke district, KwaZulu-Natal, South Africa as a case study, we report on three study objectives: (1) to determine the extent of the engagement of NGOs and CCWs in the implementation of collaborative TB/HIV including PMTCT; (2) to identify constraints related to provision of TB/HIV/PMTCT integrated care at community level; and (3) to explore ways of enhancing the engagement of CCWs to provide integrated TB/HIV/PMTCT services. Our mixed method study included facility and NGO audits, a household survey (n = 3867), 33 key informant interviews with provincial, district, facility, and NGO managers, and six CCW and patient focus group discussions.ResultsMost contracted NGOs were providing TB or HIV support and care with little support for PMTCT. Only 11% of facilities’ TB and HIV patients needing care and support at the community level were receiving support from CCWs. Only 2% of pregnant women reported being counseled by CCWs on infant feeding options and HIV testing. Most facilities (83%) did not have any structural linkage with NGOs. Major constraints identified were system-related: structural, organizational and managerial constraints; inadequate CCW training and supervision; limited scope of CCW practice; inadequate funding; and inconsistency in supplies and equipment. Individual and community factors, such as lack of disclosure, stigma related to HIV, and cultural beliefs were also identified as constraints.ConclusionsNGO/CCW engagement in the implementation of collaborative TB/HIV/PMTCT activities is sub-optimal, despite its potential benefits. Effective interventions that address contextual and health systems challenges are required. These should combine systematic skills-building, an enhanced scope of practice and consistent CCW supervision with a reliable referral and monitoring and evaluation system.

A Brief Educational Intervention About Pain and Aging for Older Members of the Community and Health Care Workers

Developing educational interventions about pain may lead to improved pain management for older people. A public group educational session, entitled “Pain in the Older Person,” was presented in 7 cities across Canada (Vancouver, Calgary, London, Toronto, Ottawa, Montreal, and Halifax). The presentation lasted approximately 90 minutes and was followed by a question and answer period of at least 20 minutes. Prior to the educational session, participants provided demographic data and completed measures of pain intensity, frequency, interference, and treatment; of subjective health; and of knowledge about pain. Following the session, participants completed the same knowledge items again as well as items assessing satisfaction. Data were provided by 54 health care workers (HCW) and 54 older community members (66.3 ± 10.2 years old). Prior to the educational session, knowledge gaps were evident among the older community members, especially about analgesic use. Among the HCW, knowledge gaps were found about addiction and the relationship between pain and aging. Comparison of knowledge scores before and after the educational session revealed that both groups demonstrated significant knowledge gains. Satisfaction scores were very high, with no significant difference between HCW and older community members. This is the first study to show that a brief educational intervention is associated with gains in knowledge about pain and aging among both older community members and HCW. These results suggest that a brief public educational session is a promising method of pain education that may reduce barriers to pain management in older people. PerspectiveThis article describes the results of a brief public educational session about pain and aging attended by older members of the community and health care workers. This intervention could potentially improve pain management for older people.

Health system barriers to implementation of collaborative TB and HIV activities including prevention of mother to child transmission in South Africa

In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers' and community care workers' (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB/HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility- and community-based organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB/HIV activities including PMTCT will require political will and leadership to address these health systems barriers.

Training community care workers to provide comprehensive TB/HIV/PMTCT integrated care in KwaZulu‐Natal: lessons learnt

To describe a participatory approach to implement and evaluate ways to integrate and train community care workers (CCWs) to enhance collaborative TB/HIV/PMTCT activities, and home-based HIV counseling and testing (HCT) at community level. The intervention study was conducted in Sisonke, a rural district of KwaZulu Natal, South Africa. A baseline household (HH) survey was conducted in 11 villages. Six villages were randomly selected into intervention and control clusters. Training was provided first to CCWs from the intervention cluster (IC) followed by the control cluster (CC). Routine monthly data from CCWs were collected from March-December 2010. The data was subjected to bivariate tests. The baseline HH survey revealed that of 3012 HH members visited by CCWs in 2008, 21% were screened for TB symptoms, 7% were visited for TB adherence support and 2% for ART adherence, and 1.5% were counselled on infant feeding options. A total of 89 CCWs were trained. Data show that during the study period in IC, 684 adults were offered HCT by CCWs, 92% accepted HCT and tested and 7% tested HIV-positive and were referred to the clinic for further care. Of 3556 adults served in IC, 44% were screened for TB symptoms and 32% for symptoms of sexually transmitted infections (STIs) and 37% of children were traced as TB contact. Out of 6226 adults served in CC, 10% were screened for TB symptoms and 7% for STI symptoms. The differences in uptake of services between IC and CC were statistically significant (p<0.05). The findings of this study suggest higher uptake of TB and STI symptoms screening, TB contact tracing and home based HCT in the intervention clusters. This study suggests that up-skilling CCWs could be one avenue to enhance TB/HIV case finding, TB contact tracing and linkages to care.

(P2-21) Differences in Self-Protective Behavior between Hospital Workers and Community Care Workers in Israel during the Peak of A/H1N1 Pandemic

BackgroundEffective function of the community care system is important during a pandemic. Self-protective behavior might help stop the spread of the disease during a pandemic and prevent system dysfunction because of personnel morbidity.ObjectiveTo compare the immunization rate and reported self-protective behavior of healthcare workers between hospitals and community care clinics during the peak of the winter A/H1N1 pandemic in Israel.MethodsA questionnaire was completed by 1,147 healthcare workers in 21 hospitals and 40 primary care clinics in Israel between 26 November 2009 and 10 December 2009 (the peak of the winter A/H1N1 flu outbreak).ResultsThe rate of vaccination against A/H1N1 among hospital workers (27.9%) was significantly higher compared with primary care clinics workers (19.3%) (OR = 0.691 (0.821–0.582)).

Advancing HIV/AIDS Domestic Agenda: Social Work and Community Health Workers Unite

The Obama administration's National HIV/ AIDS Strategy (NHAS) (Office of National AIDS Policy, 2010) is the context for a watershed domestic HIV/AIDS agenda. This three-pronged approach of reducing HIV incidence, increasing access to care and optimizing health outcomes, and reducing HIV-related disparities is both a long overdue and a welcomed strategic move. Social workers having long been engaged in HIV/ AIDS efforts (Wheeler, 2007)--will certainly appreciate this policy development as an opportunity for reinvigorating professional and community efforts in this arena. Even with this major national policy shift, the task of reducing the persistent disparities in HIV/AIDS incidence and prevalence among socially, racially, and economically marginalized groups is at best daunting. Changes in health care service delivery, immigration views and policies, and funding biomedical and pharmacological advances are a few of the many challenges social workers 30 years into the epidemic face. The landscape for HIV/AIDS service design, delivery, and evaluation will require advanced professional knowledge and renewed community-engaged efforts. In this new era of domestic HIV/AIDS focus, social work as a profession has a great opportunity to again demonstrate its worth in professional practice and community-engaged service delivery. Bringing the best HIV/AIDS prevention and intervention services to the most at-risk individuals and communities requires community-informed and community-engaged responses. Social workers, while having much to offer, also have the opportunity to build on their professional knowledge and skills. In this regard, the community health worker (CHW; also known as peer-health and peer-health navigators) practice models could be highly useful for positioning social work at all levels (prebaccalaureate to advanced degree) to identify problems and mobilize resources that -will truly make a difference. CHW MODEL Spencer, Gunter, and Palmisano (2010) and Perez and Martinez (2008) clearly articulated complimentary aspects of the CHW and social ,work models of practice. Both build on a commitment to social justice and empowerment and strive for culturally anchored and long-lasting change for vulnerable groups. Among the seven core roles of CHWs are the provision of counseling and support services, serving as a mediator for communities with health and human services, and ensuring that individuals in communities receive necessary services (Spencer et al., 2010).The skills and techniques for carrying out these roles are characterized as informal or basic. Bradford, Coleman, and Cunningham (2007) suggested that an adaptation to such role provisions could hold promise for a more influential impact on identifying and providing needed services, most notably in the area of reducing barriers to care and, by extension, addressing underlying factors that complicate both access and utilization of services by at-risk and affected groups. This modification or shift in the CHW practice is specifically articulated as move towards navigation. The fundamental difference here is a move from service provision itself to a focus on navigating a system and eliminating barriers to care. At its core, this shift in focus could be important in two critical areas: (1) identifying root barriers to care through the explorative and community-engaged process and (2) contributing to a more comprehensive care-coordination model, the latter being an important element in developing a long-term approach to meeting the needs of people living with HIV and AIDS who will need highly integrated and potentially lifelong intervention services (Vargas & Cunningham, 2006). Although the vast skills of community care workers are well articulated in a body of literature spanning more than 20 years and in health areas as diverse as oral health, cancer, tobacco control, and accessing health coverage (Braithwaite, Treadwell, Ro & Braithwaite, 2006; Dohan & Schrag, 2005), several recurring problems have affected CHW services. …