In-home Services Research Articles

Telemonitoring activities of daily living in home healthcare services to support aging in place

Abstract Context Assessing older adults’ abilities to carry out their activities of daily living (ADLs) is a key determinant in the provision of homecare services for aging in place. Amidst a growing aging population and lack of human resources, continuous remote monitoring technology appears promising to support health and social care professionals (HSCPs) in identifying service needs. However, implementation studies conducted in real-life settings are lacking. This study is part of an on-going action design research project aimed at developing an ambient telemonitoring system monitoring ADLs to support clinical decision making. It focused on the initial step of implementation and aimed to understand 1) which HSCPs would want to use the system, 2) for which care recipient they requested it, and 3) for which reasons. Methods A multiple embedded case study utilizing mixed methods was conducted across 3 healthcare establishments in Quebec, Canada. Descriptive statistics from surveys and medical records was conducted to describe the profile of HSCPs and their care recipients. An inductive qualitative analysis was carried out through interviews with 23 HSCPs, in charge of 31 care recipients, to deepen our understanding of the reasons why they requested the system. Results HSCPs were primarily women (89%) occupational therapists (43%). Home care recipients were also primarily women (74%), with documented refusal of homecare services (65%), diagnosed with cognitive decline (94%), and living in a single-family home or apartment (68%). Overall, interviews revealed HSCPs challenges in getting the necessary information to assess their care recipients needs, despite the presence of in-home services and other strategies in place (e.g. informal carer support). Moreover, the telemonitoring system was perceived as promising for risk management. Conclusions There is an interest for the use of ADL telemonitoring technology in the delivery of home healthcare services for aging in place. Key messages • To facilitate its integration in practice, we explored the need for, and value of, ADLs telemonitoring technology by health and social care professionals (HSCPs) in real-life contexts. • By studying the integration of innovative technologies in home healthcare practices, such as ADLs telemonitoring, we aim to support HSCPs practice in fulfilling older adults desire to age in place.

CPS response and service factors for the child maltreatment recurrence in South Korea

ABSTRACT This study examined whether the response and service characteristics of Child Protective Services (CPS) in Korea are different between the initial reports and subsequent reports in the context of child maltreatment recurrence and to identify the CPS system factors at initial reports associated with the first recurrence and the second recurrence. Study results from 7,544 maltreatment cases show that children and families of maltreatment recurrence were likely to have more emergency separation, legal action, case closure, out-of-home placement, in-home services, and counselling services for subsequent reports compared to initial reports. Also, reporter type, time to disposition decision, out-of-home placement, caregiver receiving mental health therapy, in-home services, and counselling for family members were associated with the risk of the first recurrence and a number of field visits for investigation and mental health therapy for family members were associated with the risk of the second recurrence. Implications were discussed based on the study findings.

The impact of COVID-19 on time toxicity in patients with advanced cancer.

267 Background: The COVID-19 pandemic necessitated the rapid adoption of telemedicine but little is known about whether the changes in care delivery has led to differences in time toxicity for patients with advanced cancer. This study examines the impact of the pandemic on time toxicity, defined as the time burden of interacting with the healthcare system, by comparing healthcare contact days between pre-COVID and post-COVID periods. Methods: A retrospective cohort study was performed on patients with advanced (stage 4) cancer who died within one year of diagnosis at Kaiser Permanente Northern California between January 1, 2015 and June 30, 2023. Time toxicity was defined as the percentage of healthcare contact days over the course of survival period between cancer diagnosis and death (contact days/survival days). We included outpatient days (imaging, labs, treatment, provider visits), inpatient stays (emergency department, acute inpatient, non-acute institutional stays), and in-home days (in-home care, virtual care, home hospice). Differences between pre-COVID (diagnosed and died before March 1, 2020) and post-COVID (diagnosed after March 1, 2020) periods were analyzed using Wilcoxon tests. Results: The cohort included 9643 patients, with 6558 pre-COVID and 3085 post-COVID. Median age at diagnosis was 74 years, and the cohort was 46.9% female, largely white (64.5%), with a high comorbidity score (median Elixhauser score: 4). Post-COVID, there was an increase in institutional stay (8.7% vs. 9.3%) and outpatient service (imaging and labs) (4.4% vs. 3.1%), while in-person outpatient visits decreased (5.9% vs. 8.7%, p<0.0001). Additionally, in-home days increased (25.0% vs. 20.8%), with a significant rise in in-home virtual care (3.9% vs. 1.8%, all p<0.01). Conclusions: The COVID-19 pandemic led to notable shifts in healthcare utilization for patients with advanced cancer in the last year of life. The increase in telehealth and in-home services in the post-COVID era was accompanied by a slight increase in emergency and ancillary services. Further understanding patient experiences around these shifts is crucial for optimizing care and managing time toxicity in the evolving healthcare landscape. Description of outcomes pre and post-COVID-19 pandemic. Total Pre-COVID Post-COVID P-value Survival Days, median 86.0 84.0 89.0 0.02 Percentage of Contact, median (interquartile range) Comprehensive Contact 63.3 (41.0-92.0) 62.5 (40.7-91.0) 65.2 (41.7-94.1) 0.01 Institutional stay 9.0 (2.7-26.2) 8.7 (2.7-25.9) 9.3 (2.9-26.8) 0.11 Outpatient 12.4 (5.3-19.8) 12.9 (5.6-20.6) 11.2 (4.8-18.1) <.001 Outpatient visit 7.7 (2.8-13.4) 8.7 (3.5-14.6) 5.9 (1.6-10.7) <.0001 Outpatient service 3.5 (0.8-6.3) 3.1 (0.4-5.8) 4.4 (1.5-7.1) <.0001 In-home 22.2 (7.4-50.0) 20.8 (6.0-48.4) 25.0 (10.4-51.7) <.001 In-home care 18.1 (1.7-46.6) 17.4 (1.2-46.2) 19.2 (2.4-47.2) 0.03 In-home virtual care 2.2 (0.0-4.8) 1.8 (0.0-3.8) 3.9 (0.7-7.0) <.0001

The Efficacy of a Culturally-Adapted Group-based Parent Coaching Program for Autistic Children in China via Telehealth: A Randomized Controlled Trial.

The study aimed to examine the efficacy of a culturally-adapted, group-based parent coaching program for autistic children in China delivered via telehealth. A randomized controlled trial was conducted, with 18 parents allocated to the self-directed group that received the intervention through an online learning platform, and 19 parents allocated to the web + group therapy group, which included the same program along with weekly 1.5-hour group coaching sessions via videoconferencing. The primary outcomes were parents' mental health and children's adaptive functioning, while the secondary outcomes focused on the child behaviors, parenting stress and parenting style, and family quality of life. Linear Mixed Models were used to evaluate treatment effects across time and to model longitudinal trajectories of outcomes in both children and parents. Both intervention groups showed significant improvements in children's communication skills (F (1, 60.27) = 29.86, p < 0.001) and social engagement (F (1, 60.07) = 11.73, p = 0.001), as well as reductions in parenting stress (F (1, 59.07) = 8.76, p = 0.004) and anxiety levels (F (1, 57.62) = 4.84, p = 0.032). Additionally, the group-based parent coaching via videoconferencing was associated with greater improvements in children's quality of life (F (1, 59.95) = 5.90, p = 0.018) and parents' anxiety outcomes (F (1, 57.62) = 4.84, p = 0.032). This study demonstrated the efficacy of a culturally adapted telehealth intervention for both autistic children and their parents. The preliminary findings suggest positive outcomes in children's adaptive functioning and parents' mental well-being. Group-based parent coaching through videoconferencing could be a promising and practical model for in-home services, particularly for families with limited access to in-person services.

Hospital Readmissions Among Infants With Neonatal Opioid Withdrawal Syndrome

Although cases of neonatal opioid withdrawal syndrome (NOWS) increased 5-fold in recent years, no study has examined national hospital readmission rates for these infants. To examine hospital readmissions for infants with and without NOWS. This retrospective cohort study analyzed serial cross-sectional samples of US hospital discharge records from the Nationwide Readmissions Database for calendar years 2016 to 2020. Infants with NOWS were identified using International Classification of Diseases, Tenth Revision, Clinical Modification codes. The data analysis was performed between January 5, 2023, and May 6, 2024. Neonatal opioid withdrawal syndrome. Survey-weighted logistic regression was used to examine 90-day all-cause and cause-specific hospital readmissions. Multivariable models adjusted for sex, low birth weight, gestational age, multiple gestation, type of insurance, and year of birth. Of the 13 855 246 newborns identified in this weighted analysis, 89 018 (0.6%) were diagnosed with NOWS, of whom 53.8% were male and 81.1% born full-term (>36 weeks gestation). The 90-day all-cause readmission rate was 4.2% for infants with NOWS compared with 3.0% for those without NOWS (P < .001). After risk adjustment, the odds of all-cause readmission were higher among infants with NOWS (adjusted odds ratio [AOR], 1.18; 95% CI, 1.08-1.29). Infants with NOWS had significantly higher odds of readmissions for seizures (AOR, 1.58; 95% CI, 1.01-2.46), failure to thrive (AOR, 1.99; 95% CI, 1.36-2.93), traumatic brain injury (AOR, 2.95; 95% CI, 1.76-4.93), and skull fractures (AOR 3.72; 95% CI, 2.33-5.93). Infants with NOWS had higher odds of receiving a diagnosis of confirmed maltreatment (AOR, 4.26; 95% CI, 2.19-8.27), including for neglect (AOR, 14.18; 95% CI, 5.55-36.22) and physical abuse (AOR, 2.42; 95% CI, 0.93-6.29); however, the latter finding was not statistically significant. In this nationally representative cohort study, infants with NOWS were at increased risk of readmission for any cause as well as for trauma and confirmed maltreatment. These findings may in part reflect the dual stressors that mothers with opioid use disorder face in caring for a newborn with NOWS in the context of a substance use disorder and underscore the need for family-based, in-home services that focus concurrently on substance use treatment and parenting support.

Brief report: assessment of barriers to mental health services among caregivers of children with rare disease

BackgroundCaregivers of children with rare disease experience obstacles to securing medical care including mental health treatment services. The question posed in this study was whether barriers to accessing mental health treatment services reported by caregivers of children with rare disease differed from caregivers of children with common medical and mental health conditions, and children with mental health conditions alone.MethodAn online survey combining both quantitative and qualitative outcome measures was distributed to caregivers (n = 305) who were biological, step, foster, and adoptive parents of 374 children under 18-years-old residing at home in the United States.ResultsThere were no statistically significant differences among the caregiver groups concerning barriers to accessing mental health services based on quantified measures from the Barriers to Treatment Participation Scale. Statistically significant main and interaction effects were found on three scale items (scheduling appointments, life stress, understanding treatment). Qualitative responses among caregivers of children with rare disease emphasized difficulty finding mental health treatment, lack of competent professionals, financial burden, and problems with insurance coverage.ConclusionDespite non-significant findings, several implications for families of children with rare disease are noted, namely having access to knowledgeable and experienced practitioners, making in-home services available, integrating disciplines at outpatient settings, and overcoming the costs of mental health treatment to the care required for complex medical conditions.

Daily Living Activity Recognition with Frequency-Shift WiFi Backscatter Tags.

To provide diverse in-home services like elderly care, versatile activity recognition technology is essential. Radio-based methods, including WiFi CSI, RFID, and backscatter communication, are preferred due to their minimal privacy intrusion, reduced physical burden, and low maintenance costs. However, these methods face challenges, including environmental dependence, proximity limitations between the device and the user, and untested accuracy amidst various radio obstacles such as furniture, appliances, walls, and other radio waves. In this paper, we propose a frequency-shift backscatter tag-based in-home activity recognition method and test its feasibility in a near-real residential setting. Consisting of simple components such as antennas and switches, these tags facilitate ultra-low power consumption and demonstrate robustness against environmental noise because a context corresponding to a tag can be obtained by only observing frequency shifts. We implemented a sensing system consisting of SD-WiFi, a software-defined WiFi AP, and physical switches on backscatter tags tailored for detecting the movements of daily objects. Our experiments demonstrate that frequency shifts by tags can be detected within a 2 m range with 72% accuracy under the line of sight (LoS) conditions and achieve a 96.0% accuracy (F-score) in recognizing seven typical daily living activities with an appropriate receiver/transmitter layout. Furthermore, in an additional experiment, we confirmed that increasing the number of overlaying packets enables frequency shift-detection even without LoS at distances of 3-5 m.

Mental health, negative life events and resilience among adolescents in contact with the child welfare services

Adolescents in contact with the child welfare services (CWS) are at increased risk of experiencing negative life events (NLE) and mental health problems compared to the general population. There is, however, limited knowledge of whether protective factors can promote resilience in the CWS population in the context of NLE. Data stem from the population-based youth@hordaland study conducted in 2012, comprising 9492 adolescents aged 16–19 years. In total, 283 youth confirmed contact with the CWS and were categorized as receiving in-home services (IHS; n = 138) or living in foster care (FC; n = 145). The youth provided self-report information on NLE, mental health problems and protective factors. The IHS- and FC groups reported significantly more NLE, mental health problems and fewer protective factors compared to the general population. Adolescents receiving IHS consistently reported the most problems compared to the general population. Approximately 30 % of the association between contact with the CWS and mental health problems was mediated by NLE. Further, higher scores on the protective factors predicted lower levels of mental health problems, independent of the number of experienced NLE. Small interaction effects were found for the protective factors Goal Orientation and Family Cohesion and NLE. The results highlight that protective factors can buffer against mental health problems among adolescents receiving CWS interventions. More research is needed to further disentangle the mechanisms leading to better outcomes in this high-risk group of adolescents.

Social aspects of training organization for people with limited health capacities, special educational needs and disabilities in Russia

The article examines the issues related to the provision of social services to the elderly in their home environment. The author of the article examines the practice and evaluates its effectiveness and impact on the lives of senior citizens. The article discusses the main types of in-home services, including medical care, assistance with tidiness and personal hygiene, as well as social support. The importance of the practice of in-home social services for the elderly is emphasized. It has been found that this practice allows senior citizens to maintain independence, dignity, and quality of life, as well as prevents social isolation.

Opportunities and challenges of community mental health centers in Türkiye

AbstractIn 2011, Türkiye restructured the mental health care system in community-based settings following the announcement of the National Mental Health Action Plan. Community mental health centers (CMHCs) are the major element of this approach. As of now, the total number of CMHC have reached 186, and the service users have almost reached 100.000. Mental health care system gained significant advantages through CMHCs, such as 1) improvement in the conditions of mental health services, 2) better follow-up of patients with chronic severe mental disorders, 3) capability of in-home services, 4) decrease in the number of hospitalizations, 5) increased social involvement of patients with severe mental disorder. CMHCs also played a significant role in promoting social rehabilitation, including employment status, development of social relationships, and redress of stigmatization. All these advantages were put into practice by community mental health teams comprising a psychiatrist, psychologists, nurses, social workers and ergotherapists, if available.Community mental health centers come with severe challenges and shortcomings despite their ameliorations. First, CMHCs need trained mental health professionals. However, only 52% of the CMHC teams completed the CMHC trainings currently. Second, standardized work flow algorithms should be developed for CMHCs. Third, there should be a strong relationship between CMHCs, primary health care system and inpatient units as a complementary part of essential mental health care. In addition, hospital administration should be trained in terms of CMHC policy since every CMHC is affiliated with a state hospital. For instance, the ongoing issue of defining quality standards for CMHCs contributes to a misconception, portraying these centers as profit-making units rather than dedicated rehabilitation facilities.In conclusion, community-based settings and CMHCs significantly advance mental health services despite the challenges confronted in practice. To optimize the effectiveness of community mental health care facilitated by CMHCs, it is imperative to review the implementation process with the active involvement and support of non-governmental organizations, including patient-driven organizations and national psychiatric associations.Disclosure of InterestNone Declared

Daughters rewarding mothers’ piteous lives: Eldest daughters caring for aging mothers

This study is an analysis of the personal and social meanings of married women’s experiences caring for their aging mothers as the eldest daughter in Korean society. Semi-structured interviews were conducted with seven participants for this study. The interviews were conducted in Korean, and the collected data were analyzed using descriptive phenomenological analysis in four categories: “being the eldest daughter and daughter-in-law in a patriarchal society with nothing but duties”; “the pain of taking care of my mother that invades my daily life”; “The compassion of an eldest daughter who can’t turn a blind eye to her mother’s miserable life.”; and “Support from society to overcome the psychological difficulties of caregivers and help older adults in their daily lives”. The study participants felt emotional pain in caring for their mothers, and it was difficult for them to simultaneously play the roles of daughter-in-law, wife, and mother. However, they felt compassion for their mothers’ lives in a patriarchal society and believed they could compensate for their mothers’ hardships by caring for them. The participants emphasized the need for specialized in-home services that address the specific health needs of the older adult, along with counseling services for their caregivers. In Korean society, when daughters care for their mothers, it strengthens the shared history and emotions between mothers and daughters, affirming female solidarity. Based on the above findings, policy and practical measures are recommended to ensure that daughters who provide care for their mothers can deliver stable care.

Using a structured decision-making model to inform child welfare practice in Florida: safety versus removal

ABSTRACT Child welfare professionals use structured decision-making models (SDMs) to increase consistency in decision-making. The current study examined the relationship between safety and removal decisions of case managers in Florida. Secondary data from a previous study were used. Results indicated that participants identified the home as “unsafe” 50% of the time, while recommending in-home services 75% of the time. This inconsistency in identifying a home as unsafe yet opting for in-home services was unexpected. Although limited in generalizability and interpretability, this study demonstrates the inconsistencies in decision-making and the need for a more comprehensive examination of components impacting decision-making.

A Critical Review of In-Home Services for Children with Neonatal Abstinence Syndrome and their Families

A Critical Review of In-Home Services for Children with Neonatal Abstinence Syndrome and their Families

Program of All-Inclusive Care for the Elderly (PACE) Organizations Flip the Script in Response to the COVID-19 Pandemic

ObjectivesProgram of All-Inclusive Care (PACE) organizations faced unique challenges during the COVID-19 pandemic, particularly given PACE participants are frail older adults who often live with multiple disabilities and chronic conditions. This study describes how PACE programs leveraged their unique program flexibilities and adapted services to manage this crisis. DesignMixed methods. Setting and ParticipantsThis study leveraged 2 national surveys of PACE directors (with response rates of 71.2% and 67.8%) and 6 qualitative interviews. MethodsDescriptive and univariate analyses of survey response data and thematic analyses of qualitative data from interviews and open-ended survey questions were conducted. ResultsResults indicated that PACE organizations responded rapidly to the COVID-19 pandemic, implementing a range of adaptations that shifted the PACE model from primarily center-based to a home-based model of care. Most PACE organizations reported increasing the in-home services they provided, often accomplishing this through the redeployment of center-based staff. PACE organizations likewise leveraged telehealth and remote monitoring to increase support to beneficiaries in their home, implemented various COVID-19 vaccine and infection prevention efforts, increased food and nutrition services provided in the home, and took steps to address social isolation and boredom, among other initiatives. Most PACE organizations indicated they plan to continue delivering more services in the home, consistent with participant preferences. Conclusions and ImplicationsThe findings from this study indicate that PACE organizations continued to keep participants at the forefront as they transitioned to a home-based model during the COVID-19 pandemic. Key characteristics of PACE, including its strong emphasis on person-centered team-based care, its fully integrated service model, and its flexible capitated payment structure, contributed to the resilience of the program. These findings highlight PACE organizations' ability to empower nursing home–eligible older adults to remain living in their preferred residential setting and have implications for how best to serve this population.

Hospital-to-Home: logic model and theory of change exercise to identify outcomes arising from integrated health and social care.

Introduction: Although Canada boasts universal access to hospital-based services, bed capacity has been a challenge with long wait times for acute admissions to a hospital bed from the Emergency Department. The use of hospital beds by ‘alternate level of care’ (ALC) patients is a critical concern. These ALC patients exist because of a lack of an appropriate level of care in the community. Integrated health and social care (IHSC) can limit avoidable acute care utilization including in-patient stays in hospitals. CHATS--Community &amp; Home Assistance to Seniors is a community-based agency that provides transportation, meals, in-home services, caregiver relief, education and support, community wellness, and 24/7 assisted living among other services, with the aim of supporting ageing in place. CHATS has partnered with several local hospitals and homecare providers to create a number of hospital-to-home programs (HTH) that provide seamless and coordinated care from hospital to home for older adults enabling safe and effective transitions. Hospital-based data has shown that ALC days and inpatient and ED hospital readmissions declined following implementation of HTH programs. Although hospital-based data is available, community-based health and social care outcome-based metrics have not been developed nor collected. Despite limited qualitative data showing high levels of client and caregiver satisfaction with its HTH services, the lack of outcome-based data makes it difficult for CHATS to articulate the benefits of the HTH programs from a community-based perspective that reflects both health and social care outcomes with the aim of informing policy and programming decisions in the future, including program scale and spread.&#x0D; Methodology: A logic model (LM) and theory of change (ToC) exercise was undertaken by a broad representation of CHATS staff at all levels of the organization to identify the theory of change for the HTH programs and critical activity-based and outcome-based metrics to support future measurement and evaluation work. The development of these models clarified the fundamental program theory behind community agency contributions to the HTH programs that enable their success.&#x0D; Results: The theory of change noted that the HTH program was able to achieve hospital to home transition success because it facilitates older adult clients to achieve greater self-determination that can support more independent living. The HTH program’s components, case management, personal support, transportation, training, counselling, and assessments ensure that the personal goals of clients and their caregivers are identified and addressed. Feelings of empowerment, improved mental health, health and social care navigation literacy, and reduced acute care readmissions are some of the outcomes perceived as being attributable to the HTH programs. These outcomes, in turn, allow for greater overall health and wellbeing, and sense of independence among older adult clients and their caregivers. Ultimately, the HTH programs contribute towards greater systems efficiency and enhanced quality of life for clients and their family/caregivers.&#x0D; Next steps: The results of the LM and ToC exercises have enabled CHATS to identify critical input, activity and outcome measures for the HTH programs that reflect the contributions of CHATS, and a towards a future summative evaluation of the HTH programs.&#x0D;

Improving child behavior through parent training in child welfare services: A mixed-methods study of families receiving in-home services

Behavioral parent training programs, such as Pathways Triple P (Level 5 of the Triple P parent support and training system, hereafter referred to as Pathways), have been shown to improve child behavior. However, Pathways has not been tested with a child welfare services (CWS) population. A mixed-methods, randomized control trial was conducted to examine its effectiveness with CWS-involved families. The sample included parents investigated for maltreatment whose child remained in home following the investigation. Parents were randomized into treatment (n = 57) or services-as-usual (n = 62). Regression analysis was used to test the hypotheses: (1) Parents in the treatment condition demonstrated better parenting outcomes than parents in the services-as-usual condition; and (2) Children in the treatment condition demonstrated better child behavior outcomes than children in the usual-care condition. Qualitative findings further illuminated parents’ perceptions of change in themselves and their children. Families receiving Pathways did statistically significantly better than those in the services-as-usual condition on child behavior problems, parental anger, and parenting efficacy – although effect sizes were small. Qualitative findings strongly support the quantitative findings. Pathways is a promising intervention for CWS-involved families. Efforts should be made to increase accessibility of Pathways for these particularly vulnerable families.

Examining Utilization of Formal Supports and Related Impacts on Overall Well-Being Among East Asian American Family Caregivers of Persons With Dementia: A Mixed-Methods Study.

Although East Asian American family caregivers are known to underutilize formal support services, there is a lack of evidence regarding the associations of formal service utilization with caregivers' well-being. This study examined the prevalence of different types of home-and community-based formal service utilization among Korean and Chinese American family caregivers of persons with dementia and how utilization of such services was associated with their well-being. We also explored their overall experience in accessing and utilizing formal dementia support services and programs. We employed a convergent mixed-methods study design. In a convenience sampling method, we recruited 62 family caregivers. Logistic regression and thematic analysis were utilized to analyze data. The results showed in-home services were mostly utilized among family caregivers of these ethnic groups. Out of 9 different support services, those who utilized nutrition programs and case management were more likely to report higher overall well-being. Four themes were developed: (1) awareness of formal support services but uncertainty on how to access them, (2) language barriers imposing additional challenges in accessing formal support services, (3) traveling to access culturally appropriate services, and (4) desire for culturally tailored medical and long-term care services. Findings from this study suggest the importance of case management services to overcome barriers to accessing and utilizing a wide range of formal support services and provision of culturally appropriate food in formal support services to increase East Asian American family caregivers' utilization of long-term care services.

Mourned pets. About Coping with Animal Death in Veterinary Practice and Caregiver’s Experience

The article is written from the first-person perspective as an autoethnographical attempt to describe the experience of loss of a pet companion, a cat, when the decision about euthanasia was challenged and undermined, causing regret and complex feelings about the situation. The author tries to provide explanation for her feelings and for veterinarian behavior, at the same time introducing new kind of veterinarian in-home services for palliative care and euthanasia.

Challenges and Experiences Faced by Physiotherapists in Stroke Rehabilitation: A Qualitative Study

ABSTRACT Introduction: Stroke is one of the leading causes of death and disability in India and rehabilitation therapy is underdeveloped. Neurorehabilitation is a program that caters to people who have disabilities to help them attain and maintain optimal performance. The majority of people with disabilities are economically underprivileged and have trouble getting access to basic health care (including rehabilitation). Physiotherapists also face limitations in providing services to stroke survivors and this study is to identify those challenges. Objective: The objective of this study is to identify the limitations faced by physiotherapists during stroke rehabilitation. Material and Method: In November 2022, a focus group discussion was held with a sample size of 12 physiotherapy residents from neurorehabilitation and community rehabilitation working in a tertiary hospital. After consent was taken, audiovideography was recorded, transcripted, and documented. Data were thoroughly transcribed, and thematic analysis and characteristics were established. Results: After extraction of codes and themes, the following results were found. General categories of themes are lack of awareness on stroke and physiotherapy, infrastructure, financial constraints, family dynamic, social health, amotivation and mental health, collaboration limitations, problems in-home services, and the impact of COVID-19 pandemic on rehabilitation. Recommendations given by the participants were creating a stroke community, availability of more insurance companies to support and provide relief for financial stress, early education and awareness on stroke from school level, active participation of caregivers and family members to assist the patient in home-based therapy, and availability of NGOs that cater specifically to physiotherapy. Conclusion: It was concluded that neurorehabilitation in India needs to attend to the given categories. Policymakers must be aware of the financial and social issues that stroke survivors experience and enact legislation that will decrease mental and financial stress.

Family support services and reunification across diverse racial/ethnic groups: A survival analysis utilizing administrative child welfare data

Background/ObjectiveContrary to their intention, family support services may increase the likelihood of foster care placement. Yet, few studies have examined what happens to children placed into care after receiving these in-home services, which is particularly concerning for children of color who often face disparities in successful outcomes. Using data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) and the National Child Abuse and Neglect Data System (NCANDS), this study examined the relationship between family support service utilization and reunification across diverse racial/ethnic groups.MethodData for this study come from the AFCARS and the NCANDS. All children who entered foster care in 2015 in states that reported utilization of family support services (29 states and DC) were included in this analysis (n = 178,366 children) and were tracked for four years. We conducted multivariate survival analyses to examine the likelihood of reunification depending on family support service use and race/ethnicity, among other covariates.ResultsApproximately half of the sample (50.51%) reunified during the study period. White, Hispanic, and Multiracial children had the highest utilization of family support services. After adjusting for other factors, family support services (HR = 0.95, 95% CI = 0.94–0.96) decreased the hazards of reunification. The interaction between race/ethnicity and family support services was not significantly associated with reunification.DiscussionFamily support services are not achieving their intended goal either prior to, or after removal, regardless of racial/ethnic identity. Implications are explored for policy related to reunification and for future research to explore the relationship between receipt of family support services and reunification.