Organizational social context and psychopathology of youth in residential care: The intervening role of youth–caregiver relationship quality

Drawing on an ecological approach with multiple informants, this study investigated the mediating role of youth–caregiver relationship quality in associations between different features of residential care settings' organizational social context and youth's psychopathology. Participants were 378 youth aged between 12 and 25 years old, and 54 caregivers aged between 24 and 57 years old, from 29 generalist residential youth care settings in Portugal. Given the hierarchical structure of data, analyses were performed using multilevel modeling. Results revealed that organizational social contexts characterized by higher levels of engagement, stress, and centralization, as perceived by the caregivers, were associated with lower levels of youth's externalizing problems (e.g., aggressive behavior and delinquency), reported by the caregivers, via better youth–caregiver relationship quality, perceived by the youth in care. These findings highlight the relevance of creating an organizational social context in residential care settings that supports caregivers in establishing high-quality relationships with the youth in care, thereby promoting their mental health. This study contributes to the clarification of conflicting findings in previous studies of this field, by offering further empirical investigation of these issues.     

Center-Based Care for Young Children: Examining Predictors of Quality

The authors collected information from caregivers, trained observers, and parents to investigate quality elements in child-care programs designed for young children in center-based settings. Participants were 75 parents of children aged 15 to 36 months and their caregivers from 13 child-care centers in a southeastern state. Observers collected indicators of program quality and process and structural quality indicators, including adult-child ratio, group size, use of planned activities, use of child-designated space, housekeeping activities, and caregiver-child interactions. Participants responded to questions regarding their child-rearing beliefs, social support networks, perceived stress levels, and demographic characteristics. The best predictors of higher quality care and sensitive caregiver-child interaction in centers were specialized caregiver training, higher adult-child ratios, use of planned activities, and less perceived stress by caregivers. Implications of these findings are discussed.     

Which behaviours? Identifying the most common and burdensome behaviour changes in amyotrophic lateral sclerosis

Behaviour change is increasingly recognised as a common feature of amyotrophic lateral sclerosis (ALS), and may be similar to that seen in frontotemporal dementia (FTD). The behaviours most disturbed in ALS, and those that relate most significantly to caregiver burden, however, have not been well established. Forty ALS participants and their caregivers, and 27 age- and gender-matched healthy controls and their relatives, participated in this study. ALS participants were assessed on a disease rating scale, and caregivers and control informants completed the revised version of the Cambridge Behaviour Inventory and a measure of burden. ALS caregivers reported significantly more disturbance than healthy control informants on the functional domains of everyday skills, self-care, and sleep, and in the behavioural domains of mood and motivation. There were no differences between groups in frequency of memory and orientation difficulties, or behaviours characteristic of FTD, such as changes to eating habits or stereotypic and motor behaviour, indicating that the behavioural profile in ALS may differ from FTD. In the ALS group, the domains with the strongest relationship to caregiver burden were everyday skills, motivation and memory, likely because poor motivation, memory dysfunction and difficulties completing activities of daily living require more carer support via direct supervision, prompting or hands on care. Services to support ALS patients and caregivers need to provide targeted interventions for those functional and behavioural changes which are most burdensome in the disease.     

Counselors Within the Chronic Care Model: Supporting Weight Management

The Chronic Care Model developed for the multidisciplinary management of chronic diseases provides a blueprint for the integrated role of mental health counselors supporting clients with obesity seeking weight management treatment. Counselors can support clients and the team of health care professionals treating obesity within each of the 6 components of the model: (a) health care organization, (b) delivery‐system design, (c) clinical information systems, (d) decision support, (e) client self‐management support, and (f) community resources.     

Psychosocial Well-being of Children in HIV/AIDS-Affected Families in Southwest China: A Qualitative Study

We investigated the psychosocial well-being of children in HIV/AIDS-affected families in rural China from the child’s and caregiver’s perspectives. Semi-structured interviews were conducted among children living in HIV/AIDS-affected families (n = 16), their caregivers (n = 16) and key community informants (n = 5). Our findings showed that all of the children relied heavily on caregivers and peers to gain psychological support. Children’s psychosocial problems included fear, anxiety, grief, and loss of self-esteem and confidence. Stigma towards children existed, including isolation, ignorance and rejection. Our study illustrates that HIV/AIDS has impacted negatively on the psychosocial well-being of children. These findings can be used as preliminary data supporting more researches to profoundly explore the psychosocial impact of HIV/AIDS on children and appropriately indicate the need for interventions.     

Care for Caregivers: Understanding the Need for Caregiver Support

Most long‐term care for older adults in the United States is provided by informal caregivers (Ahmad, 2012 ), the majority of whom experience an intense range of emotions from satisfaction to loneliness. Counselors must consider this emerging population of caretakers and learn methods to encourage clinical services to address their need for support. This article delineates experiences and challenges of informal caregivers and provides suggestions for effective clinical services for caregiver populations.     

Factors influencing the attitudes and commitment of volunteer alcohol counsellors

The attitudes of volunteer counsellors towards clients with alcohol problems and the counsellors' commitment to their agencies were investigated. A questionnaire was devised, incorporating the Alcohol and Alcohol Problems Perception Questionnaire, and was distributed to volunteer counsellors working within Volunteer Alcohol Counsellors' Training Scheme (VACTS) recognised agencies in England. Two hundred and thirty counsellors were eligible to complete questionnaires, representing approximately half of the total population of volunteer counsellors in VACTS agencies; 141 questionnaires were completed. The results indicated the importance of role recognition by agencies in enhancing counsellor attitudes towards their work; levels of experience, in terms of length of service and the number of clients seen, also appeared to be significant. Future agency commitment seemed to be positively influenced by four agency incentives, defined as role recognition, role support, training, and accreditation. Differing modes of supervision correlated positively with counsellors' attitudes towards clients and with their future agency commitment. It is concluded that voluntary agencies have an important role to play in maintaining positive attitudes and retaining their volunteer staff.     

Chaplain–Physician Consultancy: When Chaplains and Doctors Meet in the Clinical Context

This paper summarizes the perspectives of 327 Australian health care chaplains concerning their interaction with physicians within the clinical context. In general terms the findings indicated that nearly 90% of chaplains believed that it was part of their professional role to consult with physicians regarding patient/family issues. Differences of involvement between volunteer and staff chaplains, Catholic and Protestant, male and female chaplains and the type of chaplaincy training are noted, as are the perspectives of chaplaincy informants regarding their role in relation to physicians. Some implications of this study with respect to chaplaincy utility and training are noted.     

End of living: maintaining a lifeworld during terminal illness

The narrative responses of 32 people with AIDS or cancer with survival prognoses of 6 months to a year to monthly interview questions about their daily lives were analysed with a team-based qualitative methodology. Two groups emerged: (a) a Maintained Lifeworld Group characterised by one or more of the following: continued engagement with family, friends, and community; the ability to relinquish untenable goals and substitute new, realistic ones; engagement in spirituality and a spiritual practice; and, (b) a Lifeworld Interrupted Group characterised by one or more of the following: relocation just before or during the study, cognitive impairment, commitment to untenable goals, ongoing substance abuse. Understanding how people with a terminal illness can maintain a lifeworld and experience well-being while also managing the physical challenges of their illness could help inform the support offered by professional and family caregivers to improve care recipients’ quality of life.     

Pathways to mental health care by members of a rural community in South Africa

This study explored mental health help seeking pathways followed by Black South African rural community dwellers in the Limpopo province of South Africa. Ten participants (5 females and 5 males) aged between 18 and 59 years receiving services from a rural mental health care facility in the Limpopo province were the informants. They presented with psychotic disorders?=?50%, substance-use mental disorders?=?20%, mood disorders?=?20% and epilepsy?=?10%. They completed a semi-structured one-to-one interview on their pathways to mental health care services. Data were content analysed. The results showed that help seeking pathways for mental health involve several entry points. These include the utilisation of western medicine when experiencing acute symptoms, and a preference for traditional medicine when faced with chronic but manageable symptoms. The findings suggest that families and significant others are important facilitators for individuals navigating the mental health care pathways.     

The Psychology of Respite Care for People with Dementia in Australia

Australian health professional bodies promote the use of respite to ease carer burden, following well‐established findings that carers often face physical, mental, social, and financial strain while providing informal care. This narrative review examined the use and impacts of respite for older clients, with a particular focus on Australian research and on dementia respite. It was found that despite reports of high satisfaction from caregivers with respite use, barriers, such as caregiver concerns for the well‐being and safety of the care recipient during respite, limited flexibility for short‐notice respite booking, and low provision of support and education post respite, impacted on the accessibility and efficacy of respite care. It was concluded that respite care needs to move away from a custodial model to a more psychological model of care, and that more natural and flexible models (e.g., host family respite), integrated with increased post‐respite support and psychosocial education, are likely to be beneficial and need further evaluation.     

Influence of perceived social support and functioning on the quality of life of patients with schizophrenia and their caregivers

Perception of social support and functioning of patients with schizophrenia and their primary caregivers and its relationship to quality of life are described. Forty-five patients and their 45 relatives, treated at the Mental Health Services in Arica, Chile, participated. Both patients and caregivers in the study have a poor perception of social support with regard to extra-family people, as well as a low social integration. However, patients showed adequate capacity to function within their immediate family. Unlike what was found in developed countries, these patients showed moderate levels of quality of life, with a strong relationship with perceptions of the social support they receive from family and significant others and the ability to establish and maintain social contacts. Quality of life of primary caregivers is linked to patients' ability to establish and maintain social contacts within the family group, as in other social instances, such as keeping a job. The results of the study suggest the need to consider the design and application of programs of support for these patients and their caregivers, with the central aim of the social functioning of the above-mentioned patients and their familiar and community integration.     

Kinship Foster Care from the Perspective of Quality of Life: Research on the Satisfaction of the Stakeholders

A quality of life studies perspective has guided the design and implementation of research on kinship care as a placement resource within the child protection system in Catalonia (Spain). This research was carried out gathering the points of view of the three main stakeholders: kinship caregivers, children who are placed in extended family and practitioners of the EAIAs (Childhood and Adolescence Interdisciplinary Care Teams). Satisfaction involved in kinship care has been explored. In this article the main stakeholders’ satisfaction with kinship care is presented, and on the other hand, children’s satisfaction with life as a whole and with five specific domains in life is analysed: Education received from their caregiver, their school, their friends, their time enjoyment and their health. As expected, practitioners show the lowest evaluations with this kind of service. Surprisingly, evaluations by children referred to kinship care and to education received by caregivers are higher than those in the normative population aged 12–16 in relation to their own natural family. The findings show implications for practice and they imply challenges for quality-of-life research.     

The psychological experiences of foster mothers of adolescent children

The present study explored the psychological experiences of foster mothers who were fostering adolescents abandoned by their biological parents and whose parents had passed away. A purposive sample of 20 foster mothers (age range 25 to 83 years) was informants. They completed semi-structured interviews on their experiences of providing care to foster children. Thematic analysis of the data revealed the following themes: structure of the support system, crisis management, relationships management, and resilience with spirituality as coping mechanisms. Foster parenting of adolescent children requires qualities of perseverance, love, humility, and faith in carers.     

Center-based care for young children: examining predictors of quality

The authors collected information from caregivers, trained observers, and parents to investigate quality elements in child-care programs designed for young children in center-based settings. Participants were 75 parents of children aged 15 to 36 months and their caregivers from 13 child-care centers in a southeastern state. Observers collected indicators of program quality and process and structural quality indicators, including adult-child ratio, group size, use of planned activities, use of child-designated space, housekeeping activities, and caregiver-child interactions. Participants responded to questions regarding their child-rearing beliefs, social support networks, perceived stress levels, and demographic characteristics. The best predictors of higher quality care and sensitive caregiver-child interaction in centers were specialized caregiver training, higher adult-child ratios, use of planned activities, and less perceived stress by caregivers. Implications of these findings are discussed.     

Stories of family caregivers of people with dementia in Greece: Implications for counselling

A substantial body of literature has identified high rates of burden, psychological morbidity, social isolation, health and financial difficulties among dementia caregivers. The present qualitative study adopted an Interpretive Phenomenological Analysis approach in order to explore the lived experiences of dementia family caregivers within the Greek sociocultural context. The sample was purposive and consisted of 10 women dementia family caregivers from Athens and Thessaloniki. Individual in-depth interviews were conducted and analysed according to IPA. The participants’ personal accounts included themes related to ethical/existential and cultural aspects of family caregiving; changes in family relationships; impact of the caregiving experiences; sources of support and help seeking; positive and meaningful aspects of the care experience. The research findings are discussed in the context of Gilligan’s moral psychological theory, and cultural dimensions of family caregivers. Implications for counselling interventions aiming at supporting caregivers are presented.     

Meaningful involvement of people living with HIV/AIDS in Uganda through linkages between network groups and health facilities: an evaluation study

While community-based groups are able to provide vital support to people living with HIV/AIDS (PLHIV), their organizational and technical capacities are limited, and they frequently operate in isolation from PLHIV groups. We evaluated a three-year project implemented by the International HIV/AIDS Alliance in Uganda to increase the involvement of PLHIV in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for households affected by HIV/AIDS. Information sources included project monitoring data, interviews with 113 key informants, and 17 focus group discussions in 11 districts. The evaluation found that PLHIV groups reached large numbers of people with education and awareness activities and made a growing number of referrals to health facilities and community-based services. The project trained individuals living openly with HIV as service providers in the community and at designated health facilities. Their presence helped to reduce the stigma that previously deterred PLHIV from seeking care and encouraged individuals to disclose their HIV status to spouses and family members. The project has put into practice the widely endorsed principles of greater and meaningful involvement of PLHIV in a systematic manner and on a large scale. A wide audience--ranging from grassroots PLHIV networks and AIDS service organizations to national-level non-governmental organizations, government agencies, and international organizations--can benefit from the lessons learned.     

Medication Administration By Family Members of Dependent Elders In Shared Care Arrangements

Twenty-three long-term care family caregivers whose care-recipients were enrolled in adult day care programs participated in face-to-face, semistructured interviews designed to learn more about their medication administration experiences. Two distinct styles of decision making were identified: self-directed and physician-directed. To help them with their medication administration responsibility, both groups used primary (physicians, pharmacists, or both) and secondary sources of information (the internet, information hotlines, nurses, more experienced caregivers, and family members with health backgrounds). Self-directed caregivers, who were significantly younger than the physician-directed caregivers, were twice as likely to report use of secondary sources of information to manage their medication administration tasks. Secondary sources of information appear to be important for the development of a caregiver's maturation and critical thinking skills over the long term and need more attention from formal providers in shared care relationships with family caregivers.