Children's emotional and physiological responses to interadult angry behavior: The role of history of interparental hostility

Relations between history of marital discord and responses to interadult angry behavior were examined in preschoolers. Children watched/listened to an angry interaction between two adults, while their heart rate (HR) and skin conductance response (SCR) and skin conductance level (SCL) were monitored; then they were interviewed about their emotional responses to the argument. Children were also videotaped during the session and their overt behavioral distress responses were coded. In comparison to children from low-conflict homes, children from highconflict homes (a) exhibited more overt behavioral distress in response to the argument, and (b) perceived the angry interaction as less negative in affect Children's HR reactivity to the angry interaction was influenced by both marital conflict and the gender of the subject. In comparison to girls from lowconflict homes, those from high-conflict homes exhibited more HR reactivity to the argument. For boys, physical violence in the home was negatively associated with HR reactivity.I would like to thank the families who contributed their time and effort to this project, and Rebecca Blakeman for coding physiological data.     

A Survey Report of Nursing Home Ministry and Perceived Needs with Implications for Pastoral Care

ABSTRACT

The last 40 years of growth in the development of pastoral care to the sick appears to have virtually bypassed persons in nursing homes. A study within 13 nursing homes in one city revealed that spiritual ministry within those institutions was generally limited to a series of 9 to 13 worship services per month, attended by approximately 20 percent of the patients/residents. Some patients receive an occasional personal visit by a pastor. The staff perceive that pastoral ministry as good, but inadequate, and expressed their views on that which is needed within their institutions and challenge the clergy with specific suggestions for pastoral care for nursing home patients/residents, their families, and staff.     

Substitution with Interrupted Tasks of Differing Valence

The study was designed (a) to develop a form of the Home Life Scale for university men, an instrument which provides a measure of perceptions of their home life in their families of orientation; and (b) to examine the perceptions of university men in relation to selected background characteristics and to their attitudes concerning father-son relationships. No significant relationships were observed between (a) home life perceptions and (6) age, marital status, father's occupation and education, source of family income, and socioeconomic status of parents; nor were any significant relationships observed between (a) attitudes concerning father-son relationships and (b) age, marital status, father's occupation and education, source of family income, and socioeconomic status of parents. How-ever, a significant relationship (p = .05) was observed between home life perceptions and attitudes concerning father-son relationships, indicating that those Ss who hold negative perceptions concerning their families of orientation reflected the most permissive attitudes concerning father-son relationships. Such a finding suggests that men who view their own families of orientation unfavorably may wish to create in their families of procreation a warmer, less restrictive atmosphere.     

Providing therapy to children and families in foster care: a systemic-relational approach

Foster care is a system created to protect children from an unsafe home environment yet multiple foster home placements, conflictual or nonexistent relationships between foster parents and birth parents, long, drawn out court battles, and living in an on-going state of not knowing when or if they will be going home are just some of the challenges many children in care are expected to manage. This paper presents a guide for therapists working with families involved in foster care. Utilizing ideas from the postmodern therapies and structural family therapy, suggestions will be provided about who needs to talk to whom about what, when to have these necessary conversations, and how to talk to people in a way that mobilizes adults to take action for the children, with the goal of minimizing postplacement trauma, strengthening and repairing relational bonds, and moving children out of foster care and into permanent homes as quickly as possible.     

Challenges and opportunities of a transactional world view: Case study of contemporary Mormon polygynous families

Summarized an ongoing research program on contemporary Mormon polygynous families. Husband-wife and wife-wife relations in plural families are examined from dialectical and transactional world views. Key research issues center on (a) how husbands and wives achieve viable dyadic and communal relationships, and (b) how dyadic and communal issues are managed in social and physical contexts through the life cycle of plural family relationships. I wish to express my appreciation and respect for the individuals and families who welcomed us into their lives and homes during the course of this research. Their honesty, forthrightness, and commitment to religious and family life is deep and honorable. We were personally enriched by having the opportunity to learn about a unique life-style, and hope that our portrayal of aspects of participants' lives is objective, responsible, and understanding.     

ASSESSING AND IMPROVING CHILD CARE: A PERSONAL APPEARANCE INDEX FOR CHILDREN WITH AUTISM

An index of children's physical appearance and personal care was developed and used to assess youngsters with autism who lived (a) at home, (b) in an established group home, (c) in new group homes, and (d) in a large institution. Subsequently, a multiple baseline design across participants documented major changes in personal appearance and cleanliness when children moved from an institution to community-based, family-style group homes. Finally, data-based feedback generated by the appearance index was used as a training tool enabling group home staff to further improve child appearance. This research demonstrates how an evaluation instrument can be used to obtain comparative data, measure some effects of different residential placements, and provide ongoing feedback to caregivers to promote high standards of personal care among persons with severe developmental disabilities.     

Work organization, economic inequality, and depression among nursing assistants: a multilevel modeling approach

To investigate the relationships among the nursing home work environment, emotional strain, and depression in Nursing Assistants in Ohio and West Virginia, this cross-sectional study was conducted with 395 Nurse Assistants in 49 nursing homes in Ohio and West Virginia. Organizational attributes were measured independently at the individual and organizational levels. Multilevel modeling techniques were used to analyze the data. Our methods examined nursing home organizational structure (ownership type, managerial style), and work organization (emotional strain) was examined in relation to the prevalence of depression among nursing assistants. Our findings suggest workplace emotional strain and age are associated with increased odds of depression. Implications of our work include that work in nursing homes for the environment it fosters has a strong effect on emotional strain and depression among Nursing Assistants.     

Changes in resident mix in nursing homes: cognitive and sensory data from a (redesigned) sampling plan

In planning and implementing a study, we unintentionally and serendipitously obtained data about changes in resident mix over a 2.8-yr. period. We screened residents of a 184-bed nursing home for cognition and sensorium in October 1984 to assess sampling feasibility for a grant proposal in preparation. At that time, 65.2% of the residents met the sampling criteria. However, in July/August 1987, after award of funding, only 5.4% of residents of the same nursing home met the cognitive and sensory criteria. We were forced to recruit from an additional six nursing homes, in which only 9.3% of residents met the sampling criteria.     

The measurement of executive function at age 5: psychometric properties and relationship to academic achievement

This study examined the psychometric properties and criterion validity of a newly developed battery of executive function (EF) tasks for use in early childhood. The battery was included in the Family Life Project (FLP), a prospective longitudinal study of families who were oversampled from low-income and African American families at the birth of a new child (N = 1,292). Ninety-nine percent (N = 1,036) of children who participated in the age 5 home visit completed 1 or more (M = 5.8, Mdn = 6) of the 6 EF tasks. Results indicated that tasks worked equally well for children residing in low-income and not low-income homes, that task scores were most informative about the ability level of children in the low-average range, that performance on EF tasks was best characterized by a single factor, and that individual differences on the EF battery were strongly related to a latent variable measuring overall academic achievement, as well as to individual standardized tests that measured phonological awareness, letter-word identification, and early math skills.     

A Death in the Family: Report of a Single-Session Trauma Group for Nursing Home Residents and Staff

This article describes a single-session trauma-debriefing group conducted at a nursing home following the death of a resident on an outing. The group had as its core an existing weekly therapy group in the facility, with the addition of affected staff, family, and other residents who were on the outing. The treatment illustrates four principles relevant to counseling and psychotherapy in nursing homes: 1) recognition of death; 2) treatment in and of the milieu; 3) flexibility and structure; and 4) dealing with countertransference. Along the way, we see how the residents are capable of giving, and not merely receiving.     

When Disaster Strikes1

Warning responses are described on the basis of interviews with 278 randomly selected families who were evacuated from their homes prior to a flood in Denver, Colorado, on June 16, 1965. Response patterns are analyzed in detail for families who were geographically separated at the time initial warnings were received. Numerous implications for community disaster planning are explicated.     

Anxiety Symptoms as Predictors of Nursing Home Placement in Patients with Alzheimer's Disease

Anxiety symptoms are fairly common among patients with Alzheimer's Disease (AD). Such symptoms are likely to make patient care more problematic and, therefore, increase the risk of nursing home placement. Anxiety symptoms were evaluated on the basis of physician examinations, in conjunction with caregiver interviews, in 372 community-dwelling AD patients. Patients received annual follow-up for 1–12 years (M = 4.4). Patients who exhibited anxiety symptoms at baseline assessment were significantly more likely to enter nursing homes, regardless of initial cognitive status or other risks for institutionalization. There was a 15% increase in risk for each point on a 0–5 scale. This study supports the hypothesis that anxiety symptoms increase the risk of nursing home placement in patients with AD. Consequently, there is a need for better understanding of the causes of anxiety in AD and for the development of effective methods of assessment and treatment.     

Home improvements: Within-family associations between income and the quality of children's home environments

Within-family associations between changes in income and changes in the home environment during infancy and early childhood were examined using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (n = 1364). Linear and nonlinear (i.e., semilog) specifications were estimated for family income. In addition, variations in income effects were estimated as a function of the level of developmentally stimulating resources in homes during early infancy. Increases in family income were positively associated with increases in the quality of children's home environments. The estimated effects of income were largest for families who had low incomes and low-quality early home environments. These results were evident for physical characteristics of the home that likely required monetary investments, as well as for psychosocial characteristics of the home.     

Family decision-making for nursing home residents: Legal mechanisms and ethical underpinnings

Families frequently act as substitute decisionmakers for their older members who suffer from diminished mental capacity to make and express their own medical choices. Substitute decisionmaking takes on particular ethical and legal urgency within the nursing home environment, especially when choices concern potential medical treatment near the end of the nursing home resident's life. This article examines current legal mechanisms in the United States that enable a family to make substitute medical decisions, the ethical underpinnings of those mechanisms, and specific ethical and legal considerations implicated by their application to the nursing home setting. The article offers advice to nursing home professionals, including physicians, in working with families as substitute decisionmakers.     

Models for Ministry: The Spiritual Needs of the Frail Elderly Living in Long-Term Care Facilities

ABSTRACT

Litte information has been available pertaining to the spirituality of the institutionalized elderly. This paper presents the self-perceived spiritual needs of the elderly living in long-term-care facilities. Additional information is presented indicating the clergy's perceptions of these needs.

Semi-structured interviews were conducted with resident council members from three nursing homes in western North Carolina. The following three domains of spirituality were covered: (1) relationship to God; (2) relationship to church; and (3) relationship to community. Semi-structured interviews were also conducted with these residents' pastors and other clergy members who minister in these three facilities. Data collected from these interviews indicates a variation between the residents' self-perceived spiritual needs and the clergy's perceptions of these needs.

Data analyses suggested a three-step process of the resident's spiritual journey in the nursing home. This process provided a model describing the spiritual journey of the nursing home resident.     

Suicidal Intent/Life Satisfaction: Comparing the Life Stories of Older Women

The purpose of this paper is to examine the Maris hypothesis that some people have relevant biographies and life histories that predispose suicidal careers. Using a life history approach, this paper reports differing themes in the lives of two groups of older women recently relocated to a nursing home—those who are satisfied with their lives and those who are not. Twelve women were selected from a sample of 256 by their scores on a life satisfaction index or suicidal intent scale. Seventy-two hours of transcribed life histories were content-analyzed for dominant themes that contributed to either life satisfaction or suicidal intent. Strong overall themes emerged for both groups under the headings of childhood, families, role models, connectedness, confidantes, life involvement, death experience, and memories. However, the most important correlates to contribute to a suicidal career for ideators were dysfunctional families of origin, poor role models, a feeling of isolation, and a pessimistic outlook.     

Love and space in the nursing home

Nursing homes and other institutionsdesigned for persons with impairments are not,in fact, designed for persons with impairments.They are typically designed for theimpairments, not the persons, and therebybecome a part of the problem by reinforcingphysical and cultural manifestations of theimpairments. In the essay that follows, Idescribe an architectural design project inwhich students were asked to make changes to anexisting nursing home for the persons who livedthere. This requires not only becoming familiarwith the spaces, but with the personsthemselves and designing space to helparticulate their voices and being. This revised version was published online in June 2006 with corrections to the Cover Date.     

Factors Influencing Level of Stress During the Nursing Home Decision Process

This investigation examined whether characteristics of elders and their caregivers and facets of the nursing home decision-making context were associated with recalled levels of stress during nursing home decision-making. Employing a conceptual framework based upon the literature on caregiver stress and nursing home decision-making, we considered a number of factors that might influence sponsors' stress as decisions were being made about nursing home placements. We examined data from telephone interviews with a sample of 142 sponsors (responsible parties) of first-time, recently admitted nursing home residents. Higher levels of reported stress were directly associated with more factors triggering the decision to admit, higher levels of competing demands, and limited time. Employment was indirectly related to higher stress through its impact on demands. Hospitalization and being the spouse or an adult child of the resident were indirectly related to stress because they were associated with limited available time. The results offer some insights into the types of individuals who may be vulnerable to higher levels of stress and the kinds of interventions that might avert high stress in the nursing home decision process.     

Pro-active positioning of a social robot intervening upon behavioral disturbances of persons with dementia in a smart nursing home

Behavioral disturbances of persons with dementia residing in a nursing home impose a significant burden on other residents and on the care staff. A social robot can provide an adequate technological support tool for the caregivers by approaching a resident that exhibits a behavioral disturbance. In this paper, we focus on how to position the robot in the nursing home, taking into account the profile and location of the residents. We minimize the time between the detection of a behavioral disturbance and the robot having arrived near the resident and starting an interaction scenario. Our algorithm is evaluated using realistic data that was collected during 3 months in two Belgian nursing homes.     

Treatment Foster Care in a System of Care: Sequences and Correlates of Residential Placements

We examined Treatment Foster Care (TFC) in residential trajectories for youth with psychiatric disorders and aggressive behavior. We analyzed residential placements of a statewide sample of youth during the 12 months preceding and following admission to TFC. Prior to TFC, the majority of youth were residing in more restrictive settings (group homes or residential treatment). Two-thirds of youth remained in TFC throughout the follow-up year. Of those who left, nearly half returned home, and slightly fewer were discharged to group homes. By the end of the 12-month follow-up period, rates of group home use were similar to those seen in the pre-TFC period. Movement out of TFC during the year was associated with being older at placement and with increased problem behavior (particularly externalizing behaviors). TFC serves as a step-down placement for a substantial number of youth. However, this is not the only way it is used, and models based on short-term transitioning or reunification with families may not be widely implemented or relevant in practice. Additional research is needed to understand current functions of TFC in residential trajectories and to maximize its utility in systems of care.