Residential Care Institutions Research Articles

START NOW WebApp—promoting emotion regulation and resilience in residential youth care and correctional institutions: study protocol for a cluster randomized controlled trial

BackgroundAdolescents and young adults in residential care and correctional institutions face various challenges, leading to negative life outcomes. Implementation barriers within these institutions, such as limited financial and spatial resources, pose significant hurdles to providing necessary support. Web-based approaches address these challenges by offering cost-effective, accessible solutions. This study aims to assess the efficacy of a newly developed web-based version of the existing evidence-based START NOW skills training in fostering emotion regulation and resilience among institutionalized adolescents and young adults. We present the study protocol (Version 5, August 2023) of the trial titled “Implementation of an e-version of the skills training START NOW for promoting emotion regulation and resilience in residential youth care and correctional institutions”.MethodsThe study is a monocentric, prospective, confirmatory randomized controlled trial with 150 institutionalized adolescents and young adults with a need to improve resilience (predefined cut-offs). Participating institutions will be randomized to one of three conditions: (i) 9-week web-based group training guided by a facilitator, (ii) 9-week web-based self-help training, (iii) and treatment as usual. The primary endpoint is the change in psychological flexibility, assessed by the Avoidance and Fusion Questionnaire for Youth score, from baseline to follow-up 12 weeks post skills training. Secondary objectives encompass assessing pre-post changes in psychological flexibility and other psychological health-related outcome measures in participating adolescents, young adults, and caretakers from baseline, to post training, and to 12- and 24-week follow-ups.DiscussionThis study evaluates the efficacy of START NOW as web-based training for institutionalized adolescents and young adults, providing valuable insights into web-based interventions and aiming to optimize support levels.Trial registration {2a and 2b}ClinicalTrials.gov NCT05313581. Registered on 6 April 2022.

Development of a Child-Informed Measure of Subjective Well-Being for Research on Residential Care Institutions and Their Alternatives in Low- and Middle-Income Countries

Abstract10% of children worldwide live in households without a biological parent, and 5.4 million children live in residential care institutions. This study describes a participatory, child-informed process of developing a multidimensional measure of child subjective well-being tailored towards the priorities of children who have lived in residential care. Eight focus groups were held with n = 49 adolescents reunified with family after living in residential care in Kenya and Guatemala and six focus groups were held with n = 29 young adults who had lived in residential care during childhood. After analysis of the focus groups, and using the Orphans and Vulnerable Children Wellbeing Tool as a foundation, the resulting tool contained 43 survey questions. Member checking, translation, and cognitive interviewing were conducted. The survey was administered to N = 180 young people in Kenya and Guatemala who were reunified with family after living in residential care or at risk of entering residential care. Exploratory factor analysis indicated that the measure had three salient factors with good convergent validity and internal consistency: care and safety (12 items), basic needs (13 items), and leisure and freedom (7 items). This study contributes a new, psychometrically validated survey measure that can be used to assess the well-being of children connected to residential care, as well as a replicable model for creating contextualized quantitative measures via child participation that can inform policymaking on children’s care in low- and middle-income countries.

Continuation of implementation processes in residential long-term care : Sustainability of the expert standard "Relationship management in the care of people with dementia"

Nursing institutions are facing many challenges due to evidence-based requirements. For example, they are required to introduce new interventions such as expert standards and thus adapt routine practices to new findings; however, if new interventions are continuously implemented in the facilities their sustainability is questionable. The aim was to find out how sustainably the expert standard "Relationship management in the care of people with dementia" is implemented in residential long-term care institutions. Qualitative, guideline-based interviews were conducted with persons from residential long-term care, oriented to the procedure of the problem-centered interview. The interviewees were involved in the model implementation of the expert standard "Relationship management in the care of people with dementia"'. The data were then analyzed using qualitative content analysis. The participants assessed the sustainable implementation in different ways. Some rated the sustainability of the expert standard in their institution as successful, while others see potential for improvement. According to the participants, the sustainability of continuation of implementation processes is influenced by various factors. These relate to the institution, the external context, the intervention, the implementation process, and the people involved in the implementation. On the basis of the factors identified, key needs can be derived for nursing practice, for science and research as well as for politics and legislation, so that the sustainability of expert standards and other evidence-based interventions can be ensured and, if necessary, optimized.

‘Adoption is Kinda Hard and Kinda Cool’: Residential care children's views on adoption and preparation for adoption

AbstractPreparing children for adoption is one of the major goals of the child welfare system. Research on adoption preparation has mainly focused on the perspective of adults, and studies addressing the views of children eligible for adoption are meagre. This study aimed to contribute to filling this gap by exploring the child's perspective on adoption and preparation for adoption. Twenty children aged 9–13 years old (seven girls) and living in residential care institutions, participated in three semi‐structured focus group interviews. Thematic analysis of the data revealed three major themes: understanding of adoption, challenges associated with adoption and preparation and other factors that facilitate adoption. The results suggest that children perceive adoption as an opportunity for a better life that involves challenges such as navigating ambivalence, distancing from biological parents and anticipated risks. Preparation for adoption is key to overcome the expected difficulties. We discussed these results considering the importance of prioritizing children's best interests and exploring practical applications of incorporating their perspectives in adoption preparation. Addressing the views of children eligible for adoption may contribute to promoting the quality of child‐centred care in adoption preparation practices.

A national survey on health-related quality of life for people with dementia in residential long-term care institutions

BackgroundHealth-related quality of life (HRQoL) is an essential outcome parameter in geriatric research; however, the available evidence is mixed regarding the factors associated with HRQoL among people with dementia. We aimed to identify factors that contribute to HRQoL among people with dementia in residential long-term care (LTC) institutions. MethodsWe randomly selected 299 of 1607 registered residential LTC institutions in Taiwan. A cross-sectional survey was conducted between 2019 and 2020, including items on demographic characteristics, comorbidities, the EuroQol-5 dimensions-5 levels (EQ-5D-5L; utility and visual analog scale [VAS] scores), the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating (CDR), behavioral and psychological symptoms of dementia, activities of daily living (ADL), and instrumental ADL (IADL). ResultsIn total, 1313 people with dementia from 267 institutions were enrolled (mean age, 76.4 ± 12.7 years). The mean EQ-5D-5L utility and VAS scores were 0.10 (standard deviation [SD] = 0.48) and 66.57 (SD = 20.67), respectively. In multivariate linear regression analysis, higher scores for ADL, IADL, and CDR sum of boxes were associated with higher utility scores. Higher VAS scores were associated with higher ADL and MMSE scores. Lower utility scores and VAS scores were associated with more frequent depressive symptoms. ConclusionADL, dementia severity, cognitive function, and depressive symptoms influenced the HRQoL of people with dementia in residential LTC institutions. Longitudinal studies should be conducted to better understand how HRQoL changes over time among people with disabilities.

‘We have similar sad stories’: A life history analysis of left-behind children in Cambodian residential care

Globally, labor migration of parents has resulted in a growing number of children and adolescents being left behind in the areas from where migrants depart. In many countries a single parent or grandparents often act as children’s primary caregivers when parents migrate, while residential care has been found to an emergent caregiving arrangement for left-behind children in Cambodia. This phenomenon raises the questions: 1) how parental migration and other contextual factors contribute to Cambodian children’s entry to residential care, and 2) how do these children conceptualize and experience this type of care? This study adopts a qualitative research design to identify the major pathways into residential care for children of migrant workers in Cambodia, and to understand how the children perceive this type of care. Drawing on semi-structured interviews with 25 children currently living in residential care institutions (RCIs) and 17 stakeholders, two primary pathways into RCIs in the context of migration in Cambodia are identified. The first pathway stems from the undocumented or irregular migration of parents where the children themselves are often engaged in child labor, leading to a child’s move into an RCI following detention. The second pathway stems from the interplay of parental migration, family poverty and family instability, influencing a child’s placement in an RCI. The results show there are perceived benefits of living in RCIs, but also highlight the children’s unmet emotional needs. Overall, this study increases our understanding of children’s pathways into RCIs in a high migration context, to better inform services for children who potentially face cumulative risks from parent-child separation induced by migration and living outside family care.

Family-Centeredness in Secure Residential Treatment and Its Relationship With Parental Involvement and Adolescent Behavioural Outcomes

Various Dutch secure residential youth care (SRYC) institutions are implementing a family-centered approach aiming to increase parental involvement and improve treatment outcomes. However, it remains unclear if and how family-centeredness (FC) is related to increased parental involvement and to improved treatment outcomes of adolescents. In this study, we unravelled the relation between FC, parental involvement, and behaviour problems of adolescents in SRYC. Families of 404 adolescents admitted to one of seven participating Dutch SRYC institutions completed a survey (at the start, at the end, and at 6-months follow-up) on problem behaviour of adolescents. In addition, 411 group care workers filled out a questionnaire about their residential group’s level of FC every 6 months. Moreover, the mentor of each adolescent filled out a questionnaire about the level of parental involvement. We analysed the data using multiple mediator models. Associations were found between FC and parental involvement. However, no relation was found between FC and adolescent problem behaviour, and no mediation and no moderation effects of parental involvement were found. Overall, results showed that most parents were involved during the residential stay, and, independent of FC, adolescent problem behaviour decreased over time. Implementing FC in SRYC institutions seems to be helpful in involving parents during the residential stay, but was not found to be associated with adolescent behavioural outcomes. Our results indicate that institutions could improve their level of FC by offering more informal contact moments for parents and by addressing barriers to FC among residential staff.

PROTOCOL: Psychometric properties of instruments for measuring elder abuse and neglect in community and institutional settings: A systematic review.

The psychometric properties of elder abuse measurement instruments have not been well-studied. Poor psychometric properties of elder abuse measurement instruments may contribute to the inconsistency of elder abuse prevalence estimates and uncertainty about the magnitude of the problem at the national, regional, and global levels. The present review will utilise the COSMIN taxonomy on the quality of outcome measures to identify and review the instruments used in measuring elder abuse, assess the instrument's measurement properties, and identify the definitions of elder abuse and abuse subtypes measured by the instrument. Searches will be conducted in the following online databases: Ageline, ASSIA, CINAHL, CNKI, EMBASE, Google Scholar, LILACS, Proquest Dissertation & Theses Global, PsycINFO, PubMed, SciELO, Scopus, Sociological Abstract and WHO Index Medicus. Relevant studies will also be identified by searching the grey literature from several resources such as OpenAIRE, BASE, OISter and Age Concern NZPotential studies by searching the references of related reviews. We will contact experts who have conducted similar work or are currently conducting ongoing studies. Enquiries will also be sent to the relevant authors if any important data is missing, incomplete or unclear. All quantitative, qualitative (that address face and content validity), and mixed-method empirical studies published in peer-reviewed journals or the grey literature will be included in this review. Studies will be included if they are primary studies that (1) evaluate one or more psychometric properties; (2) contain information on instrument development, or (3) perform content validity of the instruments designed to measure elder abuse in the community or institutional settings. Studies should describe at least one of the psychometric properties, such as reliability, validity and responsiveness. Study participants represent the population of interest, including males and females aged 60 or older in community or institutional settings (i.e., nursing homes, long-term care facilities, assisted living, residential care institutions, and residential facilities). Screening of titles, abstracts, and full texts of the selected studies will be evaluated based on the preset inclusion criteria by two reviewers. Two reviewers will be assessing the quality appraisal of each study using the COSMIN Risk of Bias checklist and the overall quality of evidence of each psychometric property of the instrument against the updated criteria of good measurement properties. Any dispute between the two reviewers will be resolved through discussions or consensus with a third reviewer. The overall quality of the measurement instrument will be graded using a modified GRADE approach. Data extraction will be performed using the data extraction forms adapted from the COSMIN Guideline for Systematic Reviews of Outcome Measurement Instruments. The information includes the characteristic of included instruments (name, adaptation, language used, translation and country of origin), characteristics of the tested population, psychometric properties listed in the COSMIN criteria, including details on the instrument development, content validity, structural validity, internal consistency, cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, responsiveness and interoperability. We will perform a meta-analysis to pool psychometric properties parameters (where possible) or summarise qualitatively.

The project “Colour Made Inclusive” as an example of creative education for youths

The purpose of this study is to present the programme of working with socially maladjusted youngsters, which is tailored to special needs of youths in one of the residential child care institutions. The theoretical background of the programme under discussion is based on cognitive–behavioral theory. The example in question consisted of several different types of classes including art classes and psychological support. Using the qualitative methods, the semi-structured interviews were used to collect the data as this study analyzed the participants’ changes in their behaviour. The most significant results of this study are the following conclusions: 1. the new programmes of working with youths based on cognitive behavioral theory (CBT) concept are necessary for the effective social rehabilitation process and restore these young people to the society, 2. social rehabilitation institutions for young people should provide them with the possibilities of changing their behaviour in the society as in the example presented in this paper.

Seizure-related complication rate in a residential population with epilepsy and intellectual disability (ECOMRAID-trial)

IntroductionThe aim of the ECOMRAID trial (Epileptic seizure related Complication RAte in residential population of persons with epilepsy and Intellectual Disability) was to study seizure-related complications (status epilepticus, respiratory complications, or other severe complications) in people with epilepsy and intellectual disability living in a residential setting. The results of the present study are a prerequisite for performing a prospective study into the effectiveness of nocturnal surveillance patients with high risk for Sudden unexpected death in epilepsy (SUDEP). Material and methodsA retrospective study was conducted in three general residential care institutions and one residential specialized epilepsy clinic. In this 5-year cohort, we collected the following data: age (at inclusion and in case of death), sex, type of residential care, different types of complications, rescue/emergency medication administration, transfers to another department (internal midcare / monitoring unit or general hospital) and a self-designed SUDEP risk score. Our primary research questions were to assess the number of patients who experienced seizure-related complications and their individual complication rates. The secondary research questions were to document the relationship of these complications with the SUDEP risk score, with the type of residential living, and with the frequency of interventions by caregivers. ResultsWe included 370 patients (1790 patient-years) and in 135 of them, we found 717 seizure-related complications. The following complication rates were found: all complications: at 36%, status epilepticus: at 13%, respiratory complications: at 5%, and other complications at 26%. In residential care institutions, we found fewer patients with complications compared to the specialized epilepsy clinic (all complications 24% vs 42%, OR 0.44, p < 0.01; status epilepticus 5% vs 17%, OR 0.27, p < 0.01; other: complications 19% vs 30%, OR 0.56, p < 0.05). In residential care institutions, we found more “other complications” than in the specialized epilepsy clinic (89% vs 71%, OR 3.13, p < 0.0001). The annual frequency of all complications together was higher in residential care institutions (range 0 to 21 vs 0 to 10, p < 0.05). Rescue medication was given to 75% of the patients, but more often in the specialized epilepsy clinic (median 2.6 vs 0.5 times/patient/year, p < 0.001). In the specialized epilepsy clinic, more patients were transferred to a midcare / monitoring unit or general hospital (56% vs 9%, OR 13.44, p < 0.0001) with higher yearly frequencies (median 0.2 vs 0.0, p < 0.001). There were no reported cases of SUDEP. The median SUDEP risk score was higher in the specialized epilepsy clinic (5 vs 4, p < 0.05) and was weakly correlated with the status epilepticus (ρ = 0.20, p < 0.001) and (total) complication rate (ρ = 0.18, p < 0.001). ConclusionWe found seizure-related complications in more than one-third of the patients with epilepsy and intellectual disability living in a residential setting over a period of 5 years. The data also quantify seizure-related complications in patients with epilepsy and intellectual disability.

Resilience in the face of adversity: classes of positive adaptation in trauma-exposed children and adolescents in residential care

Children and adolescents in residential care often face multiple traumatic experiences. However, some individuals show resilient adaptation. To depict this heterogeneity, the person-centered examination of different classes of adaptation is a powerful tool. Up to date, resilience was insufficiently addressed in this population. Data from 141 children and adolescents in residential care institutions in Austria regarding trauma history, psychopathology, behavioral adjustment, and protective factors were assessed with standardized self-report questionnaires. Distinct classes of adaptation after traumatic experiences were examined with Latent Class Analysis. Class differences regarding traumatic experiences and protective factors were analyzed with χ2 testing. Three classes were identified [resilience (66.18%), mixed psychopathology (13.97%, mixed), high psychopathology (19.85%, high)]. Only males were classified into the resilient class and only females into the high class. The high class differed significantly from the resilient class regarding cumulative trauma history and protective factors. The mixed class did not differ from the resilient class regarding trauma history, however, they differed significantly regarding protective factors. The resilient class was associated with protective factors. Strong gender differences show the relevance of a differentiated evaluation of gender-specific protective factors and resilience indicators. Fostering protective factors may be a suitable approach for tailored intervention measures.

Neighbourhood opposition to relocation of people with disabilities in Lithuania: ‘fake ethics’ in the community discourse

Abstract Like other post-Soviet countries, Lithuania inherited large residential care institutions for people with intellectual and psychosocial disabilities. The reform aimed at relocating these people to community-based group homes has been met with opposition, and the communities see it as a threat to their habitus. The news media has become an important actor in this process, in its attempt to reproduce public discourse accompanying such social change. Research using case study methodology was implemented to explore the ethical aspects of community participation in deinstitutionalization. It involved observation of different public meetings between central government and communities, content analysis of gathered data and discourse analysis of the news media publications on a resonant case of opposition to the deinstitutionalization. Although other accounts of ethics privilege those of the individual worker or organization, this article looks at the ethics of multiple actors—including the community as an actor, and thus understands ethics as multiple, dynamic and intersecting. In this sense, the account is less about individual workers and more about communities and how they change and develop. Different ethical attitudes of the main actors—Ministry of Social Security and Labour, local authorities, social care institutions and communities, shaping public and news media discourses about deinstitutionalization—were identified in the data collected. Initial unethical community discourse was met with critique from the society at large, and it forced communities to switch to ‘fake’ ethics arguments for opposing deinstitutionalization. Fake ethics was manifested as intentional disguise of prejudices against people with disabilities through citing ethical phrases of the Convention on the Rights of Persons with Disabilities, even though these words contradicted the actions of all parties participating in the discourse. Moreover, people with disabilities themselves, directly affected by the community prejudices, were absent both in public and media discourses, and this entails a risk for their successful inclusion into the community.

Frequency and predictors of placement moves for children and youth without parental care

Providing stable placement is a priority task in the care of children and youth who are separated from their families. Numerous studies document that housing instability is one of the most difficult challenges faced by social protection systems in other countries, but there is a lack of information about the situation in Serbia. The aim of this research was to determine the frequency and predictors of placement moves of children and youth out of home care. Using a retrospective research design, the authors examined the history of placement of users in residential care institutions for children and youth without parental care, from the moment of removal from the family. The sample consisted of 133 users from seven institutions in Serbia, who were of both sexes (female 57,1% and male 42,9%) and aged from 14 to 20 years (AS=16,68, SD=1,82). Data on the placement history prior to admission to the residential care, as well as the characteristics of the users, their biological family and current placement, were obtained from the official documentation. The results show that 72,2% of children and youth from the sample had at least one placement change, and 6,8% experienced four or more moves. In most cases (53,4%) the changes are non-progressive in terms of moving to placement that is equally or more restrictive. This research confirmed the findings of previous studies that placement instability is associated with mental disorders of users, older age at admission and biological family structure. The paper discusses the implications of these findings for future research and points out that focusing attention on known predictors of placement moves can contribute to stability in the care of children and youth separated from their families.

External Communication of Institutions Providing Social Services during the COVID-19 Pandemic

Crisis communication in social service organizations is an under-researched area. Nevertheless, this topic is very relevant, given the increasing threats to individuals and society. In the face of these threats, there is a growing need for effective communication in organizing and delivering social assistance. The outbreak of COVID-19 has changed interpersonal communication and the very nature of organizations’ work. This unprecedented situation has prompted an analysis of the level of preparedness of social services organizations to adapt in the long run to an acute, changed reality.&#x0D; This paper aims to investigate how daycare centers and residential care institutions were prepared to act during a crisis, with a particular focus on communication through the organization’s external channels – websites and social networks.&#x0D; The desk-based method was applied to analyze the external communication of 387 organizations providing social care and daycare services to children, the elderly, and persons with disabilities from all Lithuanian municipalities.&#x0D; In assessing the capabilities and responsibility of institutions providing social services to ensure consistent external communication, this study ranks alongside others that have examined social service provision practices during the COVID-19 outbreak. However, this study differs from others by highlighting the responsibilities of social workers in combating misinformation and fake news. The research emphasizes the need for consistent, continuous, clearly presented information. It identifies systemic and organizational gaps in the external communication skills of social service providers. It can be concluded that due to these gaps, social service provision institutions were unable to counterweigh fake news, which became “mainstream news” (Wiswanath et al., 2020) and posed a threat to public health, public safety, and human lives.&#x0D; The voice of social services’ providers was also missing in the wider socio-political context. Here, technological, legal, and political prerequisites emerged to address the knowledge gap and the technological exclusion of those at the margins of communication. Nevertheless, the study showed a lack of active participation of social service providers in this discourse, although they were closest to those experiencing the digital divide.&#x0D; The pandemic significantly adjusted the point of view on the importance of communication in social work, its goals and nature. The main weight has shifted from the pursuit of therapeutic goals toward technological, information dissemination, and risk management aspects.

Developmental research on practical models and manuals for foster parent support specialists

In addition to being a researcher, Dr Keiji Noguchi is a foster parent and so understands the importance of a support model to prevent disruption of foster children placement. Noguchi, Faculty of Education, Fukuyama City University, Japan, is leading a project focused on developmental research on practical models and manuals for foster parent support specialists. This builds on previous research from Osaka Prefecture University and seeks to show how best to support foster parents and prevent disruption. To achieve this goal, Noguchi is developing practical models and manuals to support foster parents. A key focus is on the role of specialists who are assigned to Residential Care Institutions for Children (RCIC). Noguchi believes these Institutions and foster parents both play an important role in the success of foster parenting but it is important to find an effective means to better understand the current situation regarding the support that foster parents receive from institutions, decipher what works and what doesn’t and develop recommendations in line with this. The most important aspect of this work is ensuring that the needs of foster children are realised and fulfilled and so their input is invaluable. Foster parents also need to be considered as if the needs of foster parents are being met it is more likely that the needs of foster children are, in turn, being met. As such, Noguchi and the team are conducting an interview survey on foster parent support for foster parents and professionals in RCIC that support foster parent care and have collected valuable data that has enabled them to create a manual for foster parent care support called the Foster Parent Programme.

Adverse and traumatic exposures, posttraumatic stress disorder, telomere length, and hair cortisol – Exploring associations in a high-risk sample of young adult residential care leavers

BackgroundChildhood adversities (CAs), potentially traumatic exposures (PTEs), and posttraumatic stress disorder (PTSD) are known to increase the risk for poor health outcomes, including diseases of aging and early mortality. Telomere length (TL) and hair cortisol concentrations (HCC) are biomarkers known to be associated with CA and PTEs, and PTSD, but there is considerable heterogeneity in findings. ObjectivesThis study aims to investigate the association of CAs, PTEs, and PTSD with TL and HCC in a high-risk sample of young adults who were previously placed in youth residential care institutions throughout Switzerland. MethodOur sample includes 130 participants (30.8% women, M Age = 26.5 ± 3.7 years) with previous youth residential care placements (MPlacements= 3.9). CAs and PTEs, as well as PTSD, were assessed with self-reported questionnaires and semi-structured clinical interviews. Immune cell TL was measured with quantitative polymerase chain reaction (qPCR) in whole blood. Hair samples were collected for HCC measurement and assayed with high-sensitivity ELISA. Multivariate regression models were fitted to describe the associations between CAs, PTEs, and PTSD with TL and HCC, adjusting for covariates. ResultsIn our high-risk sample, a higher burden of CAs, PTEs, Criterion A trauma, and PTSD was associated with longer TL. PTEs, Criterion A trauma, and PTSD were associated with lower HCC, however no significant associations between CAs and HCC were found. The magnitude of these effects varied depending on the dimensional or categorical nature of the stress-phenotype and the specific measure used. ConclusionsOur findings are in contrast with many, but not all, previous studies of associations between adversity and both TL and HCC. For instance, our findings are in line with other studies that find a state of hypocortisolism in PTSD. Better measurement of adversities and trauma, multisystem biomarker approaches, and more research in larger high-risk samples at the upper end of the adversity-continuum is warranted.

Emotional and behavioral problems among children and adolescents in a residential care institution in Colombo, Sri Lanka – Implications for service delivery

There is evidence that children in residential care institutions (RCI) have higher rates of psychological problems, suicide and criminal behaviour. There is only one study in Sri Lanka which has examined the psychological well-being of children in RCIs. Further evidence is needed to formulate policies related to the mental health of institutionalized children in the local context. A cross sectional descriptive study was carried out in a selected RCI, in Colombo, Sri Lanka. All children (> 4 years) and adolescents who have been in the institution for more than 3 months were included. The caregiver rated version of the Strength and Difficulties Questionnaire (SDQ) was used to assess the extent of emotional and behavioural problems. The sample included 103 children and adolescents, between 5-17years. Majority (51.5%) were females. Mean age at entering care was 6.48 years. The mean score for externalizing problems was 6.72 (SD=3.702) and the mean score for internalizing problems was 4.12 (SD=2.312). Peer problems (23.4%) and conduct problems (21.5%) were the commonest problems encountered. Only 40% of the children having clinically significant levels of problems were in contact with mental health services. A quarter of the participants had elevated levels of emotional and behavioural problems. Routine screening programmes should be carried out at regular intervals in the RCI's for early detection of children with psychological problems in institutionalized children.

PROTOCOL: Global elder abuse: A mega-map of systematic reviews on prevalence, consequences, risk and protective factors and interventions.

This is the protocol for a Campbell systematic review. The objectives are as follows: to produce a mega-map which identifies, maps and provides a visual interactive display, based on systematic reviews on all the main aspects of elder abuse in both the community and in institutions, such as residential and long-term care institutions.

Caregivers’ perspectives on preparing girls to leave care in Ethiopia

PurposeResearch on caregivers’ experiences of and perspectives on preparing young people to leave care in Africa is lacking. A clearer understanding of caregivers’ practice and experience is important for developing improved care-leaving services. The aim of this study is to describe the experiences and perceptions of caregivers providing care-leaving services at one residential care institution in Addis Abba, Ethiopia.Design/methodology/approachA qualitative description research design was used to examine the perspectives of seven caregivers and three key informants concerning the preparation of female care-leavers for leaving care and their readiness to lead an adult life in Ethiopia. Participants were purposively selected and data were collected through focus group discussions and in-depth interviews. The generated data were analysed using thematic analysis.FindingsCaregivers are passionate about their work, seeing it more as a calling than as a job, and think of themselves as parents to the children. Most reported receiving at least some training, albeit informal or ad hoc, and faced challenges because of lack of resources. Regarding their preparation of the girls for leaving care, caregivers reported inadequate success in financial literacy and savings, continued schooling, cooking, cultural literacy and aftercare support.Originality/valueThis study thus underscores the absence of a preparation for leaving care practice guideline and an independent policy that guides care-leaving in Ethiopia. Policy improvement on caregiving that recognises and values the complexity of the job of caregiving, and thus the need for greater education, is highly needed. This paper sheds light on the issue of supporting caregivers’ attempt to mentor female care-leavers in Ethiopia.

Potential mediators of the relationship between vision impairment and self-rated health in older adults: A comparison between long-term care insurance claimants in residential care institutions versus those living in the community

ObjectivesThe objective of this study was to examine the mediating roles of functional and psychological factors on the relationship between vision impairment (VI) and self-rated health (SRH) in older adults in residential care institutions versus those living in the community. DesignA cross-sectional survey study. Setting and ParticipantsWe obtained data for this study from the public Long-term Care Insurance (LTCI) database of Yiwu, Zhejiang province, China. Our data included adults aged ≥ 60 years who had received the qualification assessment from September through December 2018. In total, 2,427 elderly individuals were included for analysis, including 747 older adults in residential care institutions and 1,680 older adults living in the community. MeasuresVI and SRH were measured using participants’ self-reported information. Potentially relevant functional and psychological factors were assessed using LTCI qualification assessment data, including self-care activities, mobility, incontinence, perceived usefulness, perceived fatigue, and perceived interest. The Karlson-Holm-Breen (KHB) method was used to examine whether functional and psychological factors mediated the relationship between VI and SRH and to calculate the mediated percentage among older adults. ResultsControlling for sociodemographic characteristics, all functional and psychological factors except mobility mediated the effect of severe VI on SRH in older adults living in the community. For older adults living in residential care institutions, self-care activities, mobility, and perceived usefulness mediated the effects of both moderate and severe VI on SRH, while perceived fatigue and perceived interest mediated the effect of severe VI on SRH. ConclusionsThe findings of this study support the idea that functional and psychological factors mediate the relationship between vision impairment and self-rated health in older adults, and that different mediating pathways exist between older adults in residential care institutions and those living in the community. Our research highlights the importance of developing tailored interventions for visually impaired older adults through an integrative model to improve their overall well-being.