Children with disability are over-represented in out-of-home care (OOHC) in Australia and internationally. Yet we know little about their circumstances, placement types, support needs, and the ...outcomes of their trajectories and wellbeing through care.
We examine the wellbeing and outcomes of children with and without disabilities in OOHC.
We use panel data from waves 1–4 of the Pathways of Care Longitudinal Study (POCLS) collected between June 2011 and November 2018 by the New South Wales (NSW) Department of Communities and Justice (DCJ), Australia. The POCLS sampling framework covers all children aged 0–17 years who entered OOHC in NSW for the first time between May 2010 and October 2011 (n = 4126). A subset of these children (n = 2828) had final Children's Court orders by 30 April 2013. Among these, caregivers of 1789 children agreed to participate in the interview component of the POCLS.
We employ a random effects estimator to analyse the panel data. This is standard practice to exploit a panel database when some of the key explanatory variables are time invariant.
Children with disability have poorer wellbeing than children without disability across the three domains of physical health, socio-emotional wellbeing, and cognitive ability. However, children with disability have fewer difficulties at school and better school bonding. The type of placements – namely relative/kinship care, restoration/adoption/guardianship, foster care and residential care – have little or limited association with wellbeing of children with disability.
Children with disability tend to have lower levels of wellbeing in OOHC than children without disability, and this is driven mainly by their disability status rather than care factors.
Background:
Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients ...with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion.
Aim:
To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care.
Design:
A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients’ responses to the EQ-5D quality of life instrument.
Setting/participants:
Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital.
Results:
EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs.
Conclusion:
The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.
Globally, Indigenous children have historical and contemporary connections with government child protection services that have caused significant harm to their long-term health and wellbeing. ...Innovative, culturally secure and recovery focussed service provision is required. This paper describes a research protocol that has been designed by Indigenous researchers led by Indigenous Elders, to explore culturally secure care planning and service delivery in out-of-home care agencies in Australia. Using participatory action research methods, we will collect data using a variety of forums, including focus groups and semi-structured interviews. These data will explore the challenges for out-of-home care agencies in providing culturally secure care-planning, cultural activity and resources, and explore solutions to address factors that influence health and can assist to redress social inequities for Indigenous children. We aim to recruit approximately 100 participants for the qualitative study and 40 participants for the quantitative survey. Study participants will initially be recruited using purposive sampling, and as the study progresses will be recruited using a mixture of purposive and convenience sampling techniques. The rich data that this study is expected to yield, will inform ways to collect cultural information about Indigenous children and ways to provide cultural connections and activities that will have benefit to Indigenous children and families, and a broad range of social services.
The increasing risk of disasters worldwide poses challenges both to health care infrastructures and to home care providers, who must maintain decentralised services for those in need of long-term ...care for as long as possible, even under adverse circumstances. However, both the kind of organisational precautions that home care providers consider in preparation for disasters and the available evidence on the effectiveness of these precautions remain largely unclear. An integrative literature review was thus performed via a systematic search of several international databases in order to identify original research on organisational disaster planning by home care providers and to determine the evidence base of this research. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. Of the 286 results, 12 articles met the inclusion criteria and presented results from nine studies on disaster planning. Three overarching types of activities carried out by home care providers were identified inductively. The overall scientific quality of the studies was moderate, and none investigated the effectiveness of disaster planning by home care providers. Despite the variety of possible activities that home care providers already consider, evidence on how to make organisational disaster planning effective and sustainable remains lacking.
Mixing personal history, interviewee voices, and academic theory from the fields of care work, the sociology of work, medical sociology, and nursing, Taking Care of Our Own introduces us to the ...hidden world of family caregivers. Using a multidimensional approach, Sherry N. Mong seeks to understand and analyze the types of skilled work that family caregivers do, the processes through which they learn and negotiate new skills, and the meanings that both caregivers and nurses attach to their care work. Taking Care of Our Own is based on sixty-two in-depth interviews with family caregivers, home and community health care nurses, and other expert observers to provide a lens through which in-home care processes are analyzed, while also exploring how caregivers learn necessary procedures. Further, Mong examines the emotional labor of caregiving, as well as the identities of caregivers and nurses who are key players in the labor process, and gives attention to the ways in which the labor is transferred from medical professionals to family caregivers.
The American Academy of Pediatrics (AAP) recommends children in foster care (FC) have an initial medical evaluation within 3 days of custody initiation; however, this vulnerable population often ...suffers from disjointed care. Our aim was to improve the mean time to initial foster care evaluation (TIE) from 32 to <7 days within 12 months for children in FC in Durham County, North Carolina.
This study was a time series, quality improvement project used to target interventions within an academic clinic and a community agency. Interventions were tested through multiple plan-do-study-act cycles. Control charts of the primary outcome, the TIE, were constructed. Charts were annotated with the dates of interventions, including workshops, performance feedback, integration of state forms, identification of appointments, development of an urgent appointment pathway, and empowerment of the scheduler.
The mean TIE improved from 32 to 9 days within 12 months. Significant improvement in the following 2 process measures contributed to this: the time from custody initiation to the referral date improved from an average of 10 to 3 days, and the time from referral date to the initial evaluation improved from an average of 22 to 6 days.
Improvement interventions and increased collaboration between medical and child welfare agencies can result in significant improvement of the TIE. However, despite improvement efforts, challenges remain in meeting the AAP 3-day TIE recommendation. We recommend further assessment of the AAP guideline as it relates to implementation feasibility and health outcomes of children in FC.
Most health care services are provided in the primary health care sector, and an increasing number of elderly is in need of these services. Nonetheless, the research on patient safety culture in home ...care services and nursing homes remains scarce. This study describes staff perceptions of patient safety culture in Norwegian home care services and nursing homes, and assesses how various patient safety culture dimensions contribute to explaining overall perceptions of patient safety.
Cross-sectional surveys were conducted among healthcare professionals in Norwegian home care services (N = 139) and nursing homes (N = 165) in 2018, response rates being 67.5% and 65%, respectively. A Norwegian version of the international recognized Nursing Home Survey on Patient Safety Culture was used. Descriptive statistics and t-tests were used to explore staff perceptions of patient safety culture. We used multiple regression analyses to explore the degree to which patient safety culture dimensions could explain overall perceptions of patient safety.
The number of patient safety dimensions having an average score of more than 60% positive responses was seven out of 10 in nursing homes, and nine out of 10 in home care. Staffing had the lowest scores in both health care services. Home care services scored significantly higher than nursing homes on teamwork (eta squared = .053), while nursing homes scored somewhat higher on handover (eta squared = .027). In home care, total explained variance of overall perceptions of patient safety was 45%, with teamwork, staffing, and handoffs as significant predictors. The explained variance in nursing homes was 42.7%, with staffing and communication openness as significant predictors.
There are differences in perceptions of patient safety culture between nursing homes and home care services. Staffing is important for patient safety perceptions in both health care services. In home care, teamwork seems to be a significant contributing factor to patient safety, and building sound teams with mutual trust and collaboration should therefore be an essential part of managers' work with patient safety. In nursing homes, the main focus when building a good patient safety culture should be on open communication, ensuring that staff's ideas and suggestions are valued.
Health Care Comes Home National Research Council; Division of Behavioral and Social Sciences and Education; Board on Human-Systems Integration ...
06/2011
eBook
Open access
In the United States, health care devices, technologies, and practices are rapidly moving into the home. The factors driving this migration include the costs of health care, the growing numbers of ...older adults, the increasing prevalence of chronic conditions and diseases and improved survival rates for people with those conditions and diseases, and a wide range of technological innovations. The health care that results varies considerably in its safety, effectiveness, and efficiency, as well as in its quality and cost.
Health Care Comes Home reviews the state of current knowledge and practice about many aspects of health care in residential settings and explores the short- and long-term effects of emerging trends and technologies. By evaluating existing systems, the book identifies design problems and imbalances between technological system demands and the capabilities of users. Health Care Comes Home recommends critical steps to improve health care in the home. The book's recommendations cover the regulation of health care technologies, proper training and preparation for people who provide in-home care, and how existing housing can be modified and new accessible housing can be better designed for residential health care. The book also identifies knowledge gaps in the field and how these can be addressed through research and development initiatives.
Health Care Comes Home lays the foundation for the integration of human health factors with the design and implementation of home health care devices, technologies, and practices. The book describes ways in which the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration (FDA), and federal housing agencies can collaborate to improve the quality of health care at home. It is also a valuable resource for residential health care providers and caregivers.
Background and Rationale
Comprehensive care and service planning in home care is tailored to older people's individual needs and resources in order to support them living at home. However, little is ...known about how these individual resources and home‐care‐specific tasks are recognised in older people's care and service plans.
Aims
To describe the content of care and service plans in older people's home care with special attention to their individual resources and home‐care‐specific tasks.
Design
This was a document‐based cross‐sectional study with mixed‐methods analysis, carried out in Eastern Finland during Spring 2018.
Methods
A document analysis using the deductive Finnish Care Classification (FinCC), and an inductively developed framework of older people's care and service plans (n = 71). The data were analysed with descriptive statistical methods.
Results
Altogether, 1718 notes were relevant to the FinCC main categories: 707 (41%) focused on older people's needs and 1011 (59%) on nursing interventions. We identified 1104 notes based on the 26 inductively developed main categories: the majority (n = 628, 57%) focused on individual resources and the remainder (n = 476, 43%) on home‐care‐specific tasks. Increasing age resulted in fewer notes on safety and sensory functions. There were fewer notes on resources related to sleeping and wakefulness after longer care and service periods. An increased number of home visits resulted in more documentation on tasks related to pharmaceutical issues, including repeat prescriptions.
Discussion
Individual resources for older people were documented, to some extent, in their care and service plans. It is necessary to review these alongside home‐care‐specific tasks that support older people's independence and safety at home.
Conclusion
Individual resources need to be recognised in order to enable home‐care professionals to provide tailored, high‐quality home care services. Home‐care‐specific tasks should be supported by documentation with updated, sensitive home care classifications.
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