Group Care Programs Research Articles

Perspectives of Family Medicine Providers on Nutrition of Maternal-Infant by Group Care Visits: A Cross-Sectional Study.

Group care in child welfare and primary care settings has evolved, becoming a popular approach for maternal and infant health care. This study focuses on the perspectives of family medicine providers on group care visits for maternal and infant nutrition, a crucial aspect of primary healthcare. Hence, this study aimed to explore current practices and opinions regarding the efficacy of group care models in delivering nutrition education to mother-infant dyads. A quantitative, cross-sectional study was conducted among family physicians in Buraydah, Saudi Arabia, from June to August 2023. Participants were recruited using a randomized sampling method from primary healthcare centers. Data were collected through a well-structured, self-administered questionnaire. The total participant count was 60. Statistical analyses were conducted using descriptive and inferential methods. The majority of participants were men (n=32, 53.3%), under 30 years of age (n=31, 51.7%), and had 0 to five years of experience in medical practice (n=32, 53.4%). A high weekly volume of infant and maternal clinic visits was reported (n=44, 73.3%) but predominantly conducted individual nutrition education sessions (n=60, 100%). A significant majority (n=41, 68.3%) expressed a positive potential for group care in nutrition education. The study revealed a positive inclination among family medicine providers towards group care models for maternal and infant nutrition education. However, current practices largely involved one-on-one sessions, indicating a gap between the recognition and implementation of group care models. It underscores the need for enhanced integration of group care approaches into clinical practice, highlighting their perceived benefits in efficiency and comprehensiveness. Future steps include implementing group care programs addressing participant concerns and assessing their efficacy in educating mothers on infant nutrition.

A VIRTUAL STAFF TRAINING TO IMPROVE COMMUNICATION FOR OLDER ADULTS DURING MASK WEARING

Abstract The need for masking protocols in care centers for older adults exacerbated communication challenges in an already difficult environment. The purpose of this study was to alleviate the burden of communicating while wearing masks by providing a virtual staff training that introduced a headset amplifier and communication tips. The training was delivered via Zoom to small groups of staff at three Programs for All-inclusive Care for the Elderly (PACE®) organizations. The training included education about the impact of age-related hearing loss, instructions for using a headset amplifier, and communication tips. Staff were encouraged to use the amplifier with as many participants as possible to ease communication while wearing masks—rather than targeting participants based on hearing status. A pre/post quasi-experimental approach was undertaken. Fifty-one staff members completed the training and immediate pre/post questionnaires to measure knowledge gain. Follow-up questionnaires (including open-ended responses) were collected at 2- (n = 29), 4- (n = 23), and 6-months (n = 23) post-training. In addition, we completed one focus group (n = 5) and one in-depth interview regarding the feasibility of participation in the research project and brainstorming to increase use of the amplifiers. By integrating quantitative and qualitative findings, we highlight communication improvements when using the amplifiers and tips for integrating amplifiers into group care programs. The findings from this study will contribute to the development of a large-scale intervention to address hearing loss and support communication for older adults in group care settings.

Assessment of Somatosensory Function and Self-harm in Adolescents

Self-harm is a risk factor for suicide in adolescents, with the prevalence highest in young people in group and residential care programs. Although no established risk factors for self-harm exist, adolescents who self-harm may have decreased pain sensitivity, but this has not been systematically investigated. To assess somatosensory function using quantitative sensory testing (QST) in children and adolescents living in care grouped by the number of episodes of self-harm in the past year and compare their somatosensory profiles with community control participants to investigate associations with the incidence or frequency of self-harm. Recruitment for this cross-sectional study began January 2019 and ended March 2020. Exclusion criteria included intellectual disability (intelligence quotient <70), autism spectrum disorder, or recent serious injury. Children and adolescents aged 12 to 17 years with no underlying health conditions were recruited from local authority residential care settings in Glasgow, UK, and schools and youth groups in London and Glasgow, UK. The volunteer sample of 64 participants included adolescents ages 13 to 17 years (34 [53%] females; 50 [78%] living in residential care; mean [SD] age, 16.34 [1.01] years) with varying incidents of self-harm in the past year (no episodes, 31 [48%]; 1-4 episodes, 12 [19%]; and ≥5 episodes, 2 [33%]). Participants were tested using a standardized QST protocol to establish baseline somatosensory function. Associations between somatosensory sensitivity, incidence and frequency of self-harm, residential status, age, gender, and prescription medication were calculated. Secondary outcomes assessed whether self-harm was associated with specific types of tests (ie, painful or nonpainful). A total of 64 participants ages 13 to 17 years completed testing (mean [SD] age, 16.3 [1.0] years; 34 [53%.] females and 30 [47%] males; 50 [78%] living in group homes). Adolescents with 5 or more self-harm incidences showed significant pain hyposensitivity compared with community control participants after adjusting for age, gender, and prescription drug use (SH group with 5 or more episodes vs control: -1.03 [95% CI, -1.47 to -0.60]; P < .001). Hyposensitivity also extended to nonpainful stimuli, similarly adjusted (SH group with 5 or more episodes vs control: -1.73; 95% CI, -2.62 to -0.84; P < .001). Pressure pain threshold accounted for most of the observed variance (31.1% [95% CI, 10.5% to 44.7%]; P < .001). The findings of this study suggest that sensory hyposensitivity is a phenotype of Adolescents who self-harm and that pressure pain threshold has clinical potential as a quick, inexpensive, and easily interpreted test to identify adolescents at increased risk of repeated self-harm.

Beyond Implementation: Sustaining Group Prenatal Care and Group Well-Child Care.

Group prenatal care and group well-child care (collectively called group care) provide health care in groups. Group care is being introduced in many settings, and the model's benefits are increasingly recognized. Yet, little attention has been paid to understanding model sustainability. This study examined barriers to sustainability and offers suggestions for sustaining group care programs. This qualitative research was guided by interpretive description. Semistructured interviews with 17 professionals were conducted in 4 sites in one community to explore barriers to sustaining group care and key ingredients for sustainability. Sites were 2 clinics that had provided group prenatal care, a clinic currently providing group prenatal care, and a clinic currently providing group well-child care. Two clinics have continued providing group care and 2 have discontinued it. Participants included midwives, physicians, nurses, and nurse practitioners. Interviews were audio recorded, transcribed, and entered in ATLAS.ti. A priori and inductive coding schemes were developed; code content was compared across individuals, participant types, and settings. Five themes were identified: administrative buy-in, robust recruitment, clinician and staff buy-in, owning it, and sustainability mindset. Group care needs to be sold to many different constituencies: administrators, staff and clinicians, and patients. Furthermore, sustainability requires having a conscious awareness of the importance of sustainability from the outset, taking ownership by adapting group care to needs of settings, creating venues for expressing divergent viewpoints and problem-solving, and recognizing that these processes are ongoing with change occurring incrementally. It also includes addressing the need for long-term financing. Those implementing group care must be prepared to go beyond managing the logistics of introducing a complex new program; they must also be prepared to develop sustainability mindsets, sell the model to everyone on all levels within their institutions, and advocate for enhanced reimbursement for group care and value-driven payment systems.

Comparing the Effectiveness of Home-based and Group-Care Programs for Children and Young People: The Challenge and Path Forward

ABSTRACT It is not unusual to see research studies or published opinion pieces that claim to demonstrate that home-based interventions (HBI) are more effective than group-care (GC) programs for young people with emotional and behavioral difficulties. The claim about the comparative effectiveness of HBIs in contrast to GC programs can only be true if they serve the same population of young people by age, gender, and degree of emotional and behavioral difficulties and that the outcomes for HBIs are statistically significantly better than those for GC. There is a long-standing argument between those who think that GC programs are unnecessary in comparison to those who think a mature child welfare system will always need some GC programs, albeit for a few young people with extreme difficulties. This article explores this issue in terms of how legitimate comparisons can be made between these two forms of service and how case-mix adjustment provides an established method for doing this. The purpose is to move away from ideological posturing by advocates from either side of the argument and put the debate about these forms of service and their effectiveness onto a firmer evidence base.

Before and after implementation of group antenatal care in Rwanda: a qualitative study of women\u2019s experiences

BackgroundThe Preterm Birth Initiative-Rwanda is conducting a 36-cluster randomized controlled trial of group antenatal and postnatal care. In the context of this trial, we collected qualitative data before and after implementation. The purpose was two-fold. First, to inform the design of the group care program before implementation and second, to document women’s experiences of group care at the mid-point of the trial to make ongoing programmatic adjustments and improvements.MethodsWe completed 8 focus group discussions among women of reproductive age before group care implementation and 6 focus group discussions among women who participated in group antenatal care and/or postnatal care at 18 health centers that introduced the model, approximately 9 months after implementation.ResultsBefore implementation, focus group participants reported both enthusiasm for the potential for support and insight from a group of peers and concern about the risk of sharing private information with peers who may judge, mock, or gossip. After implementation, group care participants reported benefits including increased knowledge, peer support, and more satisfying relationships with providers. When asked about barriers to group care participation, none of them cited concern about privacy but instead cited lack of financial resources, lack of cooperation from a male partner, and long distances to the health center. Finally, women stated that the group care experience would be improved if all participants and providers arrived on time and remained focused on the group care visit throughout.DiscussionThese results are consistent with other published reports of women’s perceptions of group antenatal care, especially increased pregnancy- and parenting-related knowledge, peer support, and improved relationships with health care providers. Some results were unexpected, especially the consequences of staff allocation patterns that resulted in providers arriving late for group visits or having to leave during group visits to attend to other facility services, which diminished women’s experiences of care.ConclusionGroup antenatal and postnatal care provide compelling benefits to women and families. If the model requires the addition of human resources at the health center, intensive reminder communications, and large-scale community outreach to benefit the largest number of pregnant and postnatal mothers, those additional resources required must be factored into any future decision to scale a group care model.Trial registrationThis trial is registered at clinicaltrials.gov as NCT03154177.

Effect of Mothers' Educational Supportive Care Program on Pain Intensity and Crying Duration Caused by Colic Pain in Infants Aged 1-5 Months

Background: Baby colic is one of the most common digestive problems in infants. Due to its several and unknown causes, colic treatment depends on the parent's individual and social education and support. Aim: This study aimed to determine the effect of mothers' educational supportive care program on the pain intensity and crying caused by colic in infants aged 1-5 months. Method: This study was conducted based on a randomized controlled clinical trial. This study included 88 infants with colic who were referred to a specialized pediatric clinic at a public hospital in eastern Iran. The patients were randomly divided into the intervention and control groups. The educational supportive care program was implemented for eight days and the infant crying duration and frequency were recorded each day. On the other hand, the control group received the clinic routine care. Subsequently, the data were analyzed in SPSS software (Version 21). Results: The two groups were homogeneous in terms of demographic variables (P<0.05). According to the results of the paired t-test, the infant pain intensity in the intervention and control groups was 0.7±1.7 and 0.7±1.7, respectively (P<0.001). Moreover, the duration of the crying caused by colic pain based on the Wilcoxon test was 6.2±22.8 and 6.2±8.9 min in the intervention and control groups, respectively (P<0.001). Implications for Practice: Individual education and provision of an educational supportive care program can affect infants' pain and cry. Therefore, it is suggested that further studies provide a group and peer educational supportive care program.

痴呆症高齢者に対する新たなグループケアプログラムの開発 : セッションの場で起きたこと,引き出された力

痴呆症高齢者に対する新たなグループケアプログラムの開発 : セッションの場で起きたこと,引き出された力

Pathways Forward for Embracing Evidence-Based Practice in Group Care Settings

Evidence-based practices are often discussed but less easily implemented. Almost all the existing manualized, diagnostic-specific evidence-based practices were neither designed for nor tested in residential programs. However, a recent survey of group care providers found great interest and some success in infusing evidence-based programs and practices in serving youth. This article described four possible pathways for group care programs to pursue to advance the use of evidence-based practices and programs. These examples include using the common elements approach, building a home-grown program and its evidence, adapting an existing manualized practice for a group care setting, and adapting a residential program to incorporate an evidence-based practice. An extended case study is provided to illustrate the process and potential challenges of creating an intervention and testing it in a group care setting.

Preliminary Results of the Louisiana Sex Offender Treatment Program

The purpose of this study was to offer preliminary support for the Louisiana Sex Offender Treatment Program (LSOTP) in addressing the needs of juvenile sex offenders. Research objectives were (1) to offer statistical evidence for reductions in anxiety, depression, cognitive distortion and negative attitudes towards women comparing a group of 21 adolescents, 12 of whom received services as usual and nine of whom participated in the LSOTP. A controlled experimental evaluation design was utilized. The juvenile sex offenders were randomly assigned to the experimental group for 12 weeks receiving treatment services and a control group receiving care “as usual” in a residential group care program. Participants in the experimental group experienced statistically significant decreases in cognitive distortions related specifically to rape and molestation.The results of this study offer preliminary support of the LSOTP as a best practices alternative to other treatment modalities.

Infectious diseases in early education and child care programs.

1. Timothy R. Shope, MD, MPH* 1. *Department of Pediatrics, Division of General Academic Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA. * Abbreviations: AAP: : American Academy of Pediatrics CFOC3: : Caring for Our Children , 3rd ed ECE: : early care and education RSV: : respiratory syncytial virus Out-of-home care and education are the norms for most young children and lead to increased exposure to infectious diseases. Pediatricians need to be aware of strategies to reduce the risk of infection and guidelines for determining exclusion and return to care for mildly ill children who participate in group care arrangements. After completing this article, readers should be able to: 1. Recognize the risks of infectious diseases in children who participate in early care and education programs. 2. Understand methods for reducing infectious diseases in early care and education settings. 3. Identify which infectious diseases require exclusion from early care and education programs. Two-thirds of children younger than 6 years participate in nonparental out-of-home early education and child care. Demographic trends during the past several decades reflect an increased desire and need to work for men and women who are parents. During the first 2 years of participation, children enrolled in early care and education (ECE) programs experience a higher incidence of respiratory and diarrheal infections, otitis media, and antibiotic-resistant bacteria compared with their peers primarily cared for at home. The types of infection generally reflect common respiratory and gastrointestinal viruses in circulation in the community. However, there are some infectious diseases that can cause outbreaks or clusters of infections in ECE settings. When ill children are excluded from an ECE facility, parents may miss work, lose income, and seek health care services in an effort to return their children to child care. Pediatricians need to be aware of the infectious disease risks of child care attendance and various strategies for reducing them. In addition, pediatricians need to be knowledgeable about rational exclusion and return …

Going Home Again: Transitioning Youth to Families After Group Care Placement

This paper presents results from the transitioning youth to families intervention, which aimed to promote family care for youth served in group care programs in the child welfare system. The intervention was conducted in two counties in a Mid-Atlantic state. The effort encompassed administrative case review and family involvement meetings. We assessed the effect of the intervention in promoting placement in family settings within 12 months. We also explored other effects of the intervention identified by participants. Using propensity score matching with administrative data to compare one-year placement settings for the intervention counties and non-intervention counties, a higher rate of family reunification was identified for youth in the treatment counties. To provide a richer contextual understanding of the effects of the intervention, thematic analysis of open-ended comments from youth and caregiver participants was conducted. These resulting themes provided further understanding of the value of the intervention especially in the areas of planning for the transition, improving youth insight about placement options, and the importance of family involvement. Participants also made recommendations for how to enhance the intervention and promote the transition of youth from group care to family settings. Overall, the effect of the intervention in transitioning youth to family settings was nominal; however unanticipated benefits of engaging youth and family in the transition process were noted. From this evaluation, we provide suggestions for future research and the development of effort to transition youth from group care settings.

Translating evidence into practice: Supporting the school performance of young people living in residential group care in Ontario

Abstract This paper provides an overview of an on-going ‘research-to-practice synthesis’ project that explores the education and learning supports provided to youth in residential group care in Ontario. The project is focused on how group care programs support the education and learning of youth in the context of the residential program itself, since there is already much evidence that support for education in the everyday living environment from direct care givers strongly impacts on education and learning performance. The project synthesizes input from a range of stakeholders that include executive leadership of agencies, front line staff as well as youth. In addition, the project provides for a detailed review of policies and procedures for residential group care programs and their relevance to the promotion of education and learning. One outcome of the project is a Self Assessment Tool attached to this paper that allows group care providers to monitor their performance with respect to supporting the education of youth living in their programs. Although the project at the time of writing is not entirely completed, it is already apparent that there is a need for systematic and broad change in the purpose and design of residential group care across service sectors.

Guidelines for Empirical Papers on Group Care Programs

The Child and Youth Care Forum (CYCF) publishes a relatively large number of papers on youth served in residential or group care programs (in 2010, almost one-third, or 9 out of 32, of the papers were on group care). Across these papers the content of program description has varied widely. In this issue of CYCF, Lee and Barth note that knowledgebuilding about group care’s effectiveness and outcomes has been hindered by a lack of uniformity in the description of a program as well as its goals and outcomes. The basic point they make is simple but very important, and it is that a particular label may not always identify similar programs or intervention models. Residential or other group care programs may differ fundamentally on several levels but often share the same or similar label for widely differing programs, which may promote misunderstanding of the value of an individual program. Lee and Barth argue that providing clarity for external stakeholders (e.g., parents and youth) is essential and that more comprehensive and standardized program descriptions are needed to improve the research and interpretation of findings on group care programs. Reporting descriptive information about programs consistently will also facilitate systematic reviews by ensuring clearer comparison of the results from research studies. In their paper in this issue, Lee and Barth propose Group Care Reporting Standards, for which such characteristics as program goals, population served, and therapeutic components are detailed explicitly in reports on group care programs for youth. These standards specify the information that should be included in empirical papers that describe group care programs or outcomes of youth served in these programs. Lee and Barth emphasize the importance of transparency with regards to the program’s desired outcomes, population, location, size, model or theory of change, activities, staffing, and several other characteristics. This content is to be included in the methods section (or elsewhere as appropriate). Authors interested in submitting original research that include data from youth receiving group care services should therefore include all of the details noted by Lee and Barth, as relevant, in their manuscripts (See Table 1). Reviews of the literature should also attend to each of these issues (See Lee and Barth, this issue). The idea of reporting standards

Defining Group Care Programs: An Index of Reporting Standards

Group care programs, while ubiquitous, are not clearly differentiated despite differences in the population served, size, auspices, and program activities, to name a few. Words like group care, residential care and residential treatment are often used interchangeably in policy, research and practice. This paper introduces reporting standards that can be used to promote the availability of descriptive information and build towards a nomenclature and classification system that reflects the variety within the service delivery system. These reporting standards were developed and vetted with input from several national group care scholars. An index of reporting standards has implications for state systems, accreditation and licensing groups, practitioners and researchers.

Comparing outcomes for youth in treatment foster care and family-style group care

Group care programs are often criticized for producing poor outcomes, especially in light of community-based alternatives like treatment foster care that have a stronger evidence base. In this study, data from Girls and Boys Town were used to compare outcomes of youth in treatment foster care ( n = 112) and group care ( n = 716) using propensity score matching, a method that can minimize selection bias in nonrandomized designs. Eighteen background covariates were used to develop propensity scores for the likelihood of receiving treatment foster care rather than group care. Several matching methods generated balanced samples on which the outcomes were compared. Results found that group care youth were more likely to be favorably discharged, more likely to return home, and less likely to experience subsequent placement in the first 6 months after discharge. Legal involvement and residing in a home-like environment at follow-up did not differ. Positive outcomes for group care youth suggest that family-style group care programs may promote effectiveness.

Proposta de acompanhamento em grupo para idosos protetizados

A implantação de programas de reabilitação para o deficiente auditivo adulto é de grande importância, principalmente na população geriátrica, sendo necessário incorporá-los à rotina dos serviços ambulatoriais. OBJETIVO: Apresentar um programa de atendimento em grupo voltado para idosos protetizados. MATERIAL E MÉTODO: Realizar um estudo piloto do tipo clínico e experimental, com a participação de 40 idosos usuários de próteses auditivas, doadas em um Serviço Público, distribuídos em seis grupos, com no máximo oito idosos mais seus respectivos acompanhantes. O programa constou de três encontros quinzenais, onde foram transmitidas informações e orientações necessárias para adequada adaptação dos idosos ao uso das próteses auditivas. RESULTADOS: A maioria dos idosos participou dos encontros ativamente, expondo suas opiniões espontaneamente ou respondendo as questões quando solicitado. Todos os idosos foram orientados quanto à importância da aceitação da deficiência auditiva e sobre a necessidade de motivação para o uso das próteses auditivas. Além disso, ouvir depoimentos dos outros idosos pareceu facilitar a compreensão das suas próprias dificuldades e os estimulou no processo de adaptação à amplificação. CONCLUSÃO: a formação de grupos facilitou a interação entre idosos, permitiu o esclarecimento das dúvidas e estratégias de comunicação e, conseqüentemente, favoreceu o processo de adaptação.

Group follow up proposal for elderly with hearing aids

SummaryImplementing rehabilitation programs to hearing impaired adults is of great importance, mainly in the elderly population, and it is necessary to add them to the routine of outpatient care programs.Aimto present a group care program for elderly patients who are fitted with hearing aids.Material and methodto carry out a pilot study of clinical and experimental type, with the participation of 40 elderly users of hearing aids donated by the government, distributed within six groups, with maximum of eight participants jointly with their respective companions. Program consisted of three meetings every fifteen days, where information and education on the proper use hearing aids was transmitted.ResultsMost of the patients participated actively in the meetings spontaneously giving their opinion or answering questions when so requested. All elderly had been informed as to the importance of accepting their auditory deficiency and on the need to be motivated towards using hearing aids. Moreover, listening to depositions of other elderly users seemed to facilitate understanding of their own difficulties and stimulated them in the process of getting used to the sound amplification.ConclusionGroups structure facilitated interaction among aged ones, helping them to clarify communication doubts and strategies and, consequently, it promoted their adaptation.

Four Areas of Support for Child and Youth Care Workers

Developing a competent staff of child and youth care workers is a major challenge for most group care programs for children, youth, and families. Factors such as low pay, lack of preparation, and demanding working conditions have contributed to creating a workforce crisis. Several studies have been conducted to help mitigate the problems. Many of these studies and experience point to daily interactions as a major source of learning and satisfaction. In this article, with an emphasis on the parallel processes of child and youth care and staff development, I draw on the literature and more than 35 years of experience in child and youth care to construct a narrative that discusses how care of self, participation, mentoring, and atmosphere contribute to successful daily interactions. The purpose is to encourage discourse, continued discussion, and action.

Group Care Practitioners as Family Workers

This article sets out a rationale and provides a model for family work by group care practitioners. In doing so it points out that practitioners will need to avoid parent blaming attitudes and become family-centered rather than simply child-focused. Thus the critical issues to be addressed are how to ensure that a group care program is from an organization, policy, and practice perspective congruent with a family-centered model. If it is not, then a program is unlikely to be able to work successfully with birth parents and family members. Birth parents and family members will instead feel alienated and, as a result, are unlikely to cooperate with the group care program and the practitioner workforce. In fact, the program will have failed to incorporate family members into the care and treatment plan and to work with them as partners in this process even when it is in the best interest of a child or youth.