The target of this diploma paper is to describe the specific clients of the programmes for drug addicts - the group of women - mothers who have ever used drugs. To work with this target group, that means to work with the target group of their children too. These children are especially in the pre-school age. One of the institutions that provides care for these women is The Centre for Family, which is a part of The Centre for Prevention and Treatment of Drug Dependence DROP In. In this diploma paper we are going to introduce not only possibilities and methods in the former project "Integration of Family", but we are going to focus on the new project "The Sunflowers'Garden". This project is not only the aftercare for mothers, former drug addicts, but also brings possibility how to focus on the children'development. These children could be threaten by the drugs using during pregnancy and by the social surroundings too. We are going to deal with different target groups, with the group of addict women and former addict women and with the group of thein children. We are going to describe the term Aftercare and the terms of Specific Learning Disabilities and Attention Deficit (Hyperactivity) Disorder. For us it is important to know abou these diagnosis. One chapter describes how do drugs influence the...

Uppsatsens syfte är att genom familjehemsföräldrars berättelser få en ökad kunskap och fördjupad förståelse för hur eftervården tillämpas i praktiken gällande ungdomar i åldern 18 - 23 år som varit placerade i familjehem. För att uppnå studiens syfte har en kvalitativ forskningsansats använts och det empiriska materialet har framtagits genom kvalitativa intervjuer. Inom studien genomfördes sex semistrukturerade intervjuer med totalt åtta familjehemsföräldrar. Under intervjuerna var temaområden vägledande: familjehemsföräldrars bild av dagens "stöd och hjälp efter avslutad  placering”/ eftervård, familjehemsföräldrars upplevelse av ungdomarnas behov av eftervård, samt familjehemsföräldrars syn på sin funktion i eftervården. Utifrån Meads symboliska interaktionism samt Bowlbys anknytingsteori analyserades det empiriska materialet. Resultatet visar att familjehemsföräldrarna ser behovet av ett långvarigt stöd för denna målgrupp, men anser att det som idag finns inte kan kallas eftervård. Vår slutsats är att det finns stora brister i eftervården för ungdomar som har varit placerade i familjehem, samt att insatser som finns inte är funktionellt utformade för denna målgrupp. För att detta ska kunna förändras krävs att ungdomarnas och familjehemsföräldrarnas behov i eftervården blir synliga. Familjehemsföräldrars uppdrag i eftervården behöver även utvecklas och förstärkas. / The purpose of the essay is to gain an increased knowledge and in-depth understanding of the use of aftercare in the practice of adolescents aged 18 - 23, who have been placed in a family home, through foster parents stories. To achieve the aim of the study, a qualitative research approach has been used and the empirical material has been developed through qualitative interviews. The study was conducted by six semistructured interviews of eight foster parents in total. During the interviews, thematic areas were indicative: foster parents view of “support and help after leaving care” a.k.a. aftercare, foster parents perception of adolescent need for aftercare and the foster parents view of their function in the aftercare. The empirin was analyzed based on concepts within Mead´s symbolic interactionism and Bowly´s theory of attachment. The result shows that foster parents see the need for a long term support for this target group, but believes that the existing support after leaving care cannot be called aftercare. Our conclusion is that there are major shortcomings in the aftercare of adolescents who have been placed in foster families, and that efforts that are available are not functionally designed for this target group. In order for this to change, it is necessary that the adolescents and foster parents needs of the aftercare are highlighted. The foster parents assignments in the aftercare need also to be developed and strengthened.

The aim of our study is to gain increased knowledge and understanding of how young people who has been sentenced to closed institutional care experience their own possibility to participate and influence the transition and aftercare, and which, if any, importance they believe this has for their readjustment to society. The study is based on a qualitative method. The data consist of interviews with four young persons, of which three, at the time for our interviews, where in the transitionphase, and one had left the institution a few years ago. The study’s theoretical framework is based on Erving Goffmans theory about stigma and the empowerment theory. We have also used earlier studies within the area to understand and interpret our data. The result indicates deficits in terms of the young people’s possibility to participate and influence the planning and implemantation of the transition from the special home of closed institutional youth care.  The youths express a wish to be more involved and be able to influence more, yet at the same time there seems to be an acceptance among the youths concerning the fact that they are not given the possibility to participate, which can be related to a view of themselves as less worthy.

Objective: To determine whether continuity of care (COC) reduces emergency department (ED) visits and/or readmission in adolescents with psychiatric disorders. Methods: A retrospective cohort of adolescents discharged with psychiatric disorder between April 1, 2002 and March 1, 2004 was identified using hospital administrative databases. Good COC was defined as at least one aftercare contact in 30 days. Confounding by patient characteristics was adjusted for by propensity-score-matching of good and poor COC adolescents. Cox PH was used to analyze time to outcome. Results: 48.77% of adolescents had good COC. 38.39% of adolescents had ED visit or readmission in the year post-discharge. Good COC increased risk of readmission (HR = 1.38 (1.14 – 1.66)), but not of ED visits (HR = 1.14 (0.95 – 1.37)). Conclusions: COC increased risk of readmission by 38% but did not increase risk of ED visits. These findings are contextualized. Implications to adolescent mental health service delivery are discussed.

Objective: To determine whether continuity of care (COC) reduces emergency department (ED) visits and/or readmission in adolescents with psychiatric disorders. Methods: A retrospective cohort of adolescents discharged with psychiatric disorder between April 1, 2002 and March 1, 2004 was identified using hospital administrative databases. Good COC was defined as at least one aftercare contact in 30 days. Confounding by patient characteristics was adjusted for by propensity-score-matching of good and poor COC adolescents. Cox PH was used to analyze time to outcome. Results: 48.77% of adolescents had good COC. 38.39% of adolescents had ED visit or readmission in the year post-discharge. Good COC increased risk of readmission (HR = 1.38 (1.14 – 1.66)), but not of ED visits (HR = 1.14 (0.95 – 1.37)). Conclusions: COC increased risk of readmission by 38% but did not increase risk of ED visits. These findings are contextualized. Implications to adolescent mental health service delivery are discussed.

Abstract The purpose of this study was to describe intensive care unit patients’ nursing environment from patients’ point of view as well as patients’ memories of intensive care. There is also a description of the psychological quality of life three and six months after intensive care and a description of intensive care aftercare from patients’, relatives’, nurses’ and physicians’ point of view. The study was conducted with patients, relatives, nurses and physicians in a university hospital emergency intensive care unit. Mixed qualitative and quantitative methods were used in this study. The material on nursing environment and memories of ICU was explored by observing patients who were in ICU (n = 4, 96 hours of taped material) and by measuring noise (dB) and lighting (lx). The patients were also interviewed twice after ICU treatment. Psychological quality of life was studied by a quality of life instrument (n = 216, RAND-36). The experiences of ICU aftercare clinic were studied by observation and by interviewing patients (n = 10), relatives (n = 8), physicians (n = 2) and nurses (n = 2). The qualitative material was analysed by inductive and deductive content analysis; the quantitative material was analysed statistically. The ICU patients’ nursing environment consists of physical, social and symbolic environment. It also involves a lot of contacts with many different people in a noisy environment. There is very little difference between day and night in terms of activities. The ICU patients did not have a long continuous resting time during the day. After three and six months, 48.1% and 47.7% of the patients, respectively, had memories from the ICU. 23.7% of the patients had memories of relatives, nurses and physicians; 30.5% suffered from delusions, nightmares and panic disorders. When asked again after three months, 7.1% of the patients suffered from these symptoms. The patients who were treated in ICU had a lower psychological quality of life than age- and sex-matched Finnish population; this was especially emphasized in patients who suffered from delusions. The ICU aftercare clinic helps patients and relatives in the recovery process and provides important knowledge to intensive care unit specialists about patients’ recovery and the effects of ICU treatment. The ICU patients’ nursing environments is made up of components which the patients cannot influence and which can be difficult for them to understand. The staff can influence components of many ICU patients’ nursing environment that advance or impair their psychological recovery. These components include calming down the patients’ environment, respecting the patients’ day and night rhythm, patient-centred care planning and information to the patient that is correctly timed and appropriately formulated. This study produced new knowledge that helps to develop the quality of treatment of patients in intensive care unit or in intensive care aftercare. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvailla tehohoitopotilaan hoitoympäristöä sekä selvittää potilaan kokemuksia tehohoidosta. Lisäksi kuvailtiin tehohoidossa olleiden potilaiden psyykkistä elämänlaatua kolmen ja kuuden kuukauden jälkeen tehohoidosta sekä tehohoidon jälkiseurantapoliklinikan toimintaa potilaiden, omaisten, hoitajien ja lääkärien näkökulmasta. Tutkimuksessa yhdistettiin laadullista ja määrällistä tutkimusta. Hoitoympäristön ja tehohoitokokemusten tutkimiseksi aineisto kerättiin havainnoimalla tehohoidossa olevia potilaita (n = 4, 96 tuntia videoitua materiaalia) sekä mittaamalla melun ja valon voimakkuutta. Lisäksi heitä haastateltiin kaksi kertaa tehohoidon jälkeen. Psyykkistä toipumista tutkittiin elämänlaatumittarilla (n = 216, RAND-36-mittari,). Kokemuksia jälkiseurantapoliklinikalta tutkittiin haastelemalla ja havainnoimalla potilaita (n = 10), heidän omaisiaan (n = 7), poliklinikan lääkäreitä (n = 2) ja sairaanhoitajia (n = 2). Laadulliset aineistot analysoitiin induktiivisella ja deduktiivisella sisällön analyysillä. Määrällinen aineisto analysoitiin tilastollisesti. Tehohoitopotilaan hoitoympäristö muodostuu fyysisestä, psyykkisestä ja symbolisesta ympäristöstä. Potilaan hoitoympäristöön liittyy useita kontakteja useiden eri ihmisten kanssa meluisessa ympäristössä. Päivän ja yön välillä ei ole suurta eroa toiminnoissa. Potilailla ei ole pitkiä yhtenäisiä lepoaikoja vuorokauden aikana. Kolmen kuukauden jälkeen 48,1 %:lla ja kuuden kuukauden jälkeen 47,7 %:lla potilaista oli muistikuvia tehohoidosta. 23,7 %:lla potilaista oli muistikuvia läheisistä, hoitajista ja lääkäreistä. 30,5 % potilaista kärsi harhoista, painajaisista ja paniikkikohtauksista. Kysyttäessä uudelleen kuuden kuukauden kuluttua 7,1 % vastasi kärsineensä näistä oireista. Tehohoidossa olleilla potilailla oli matalampi psyykkinen elämänlaatu kuin ikä- ja sukupuolivakioidulla suomalaisella vertailuväestöllä. Erityisesti tämä korostui harhoista kärsineillä potilailla. Tehohoidon jälkiseurantapoliklinikka auttaa potilasta ja omaisia toipumisprosessissa ja antaa tehohoidon asiantuntijoille tietoa potilaiden toipumisesta sekä tehohoidon vaikutuksista. Tehohoidossa olevan potilaan hoitoympäristö koostuu osatekijöistä, joihin potilas ei voi itse vaikuttaa ja joita hänen voi olla vaikea hahmottaa. Henkilökunta voi vaikuttaa moniin niistä hoitoympäristön tekijöistä, jotka edistävät tai hidastavat potilaan psyykkistä toipumista. Näitä ovat hoitoympäristön rauhoittaminen, päivä-yörytmin kunnioittaminen, potilaskeskeinen hoitotyön suunnittelu sekä oikea-aikainen ja -muotoinen tiedonanto. Tutkimus tuotti uutta hoitotieteellistä tietoa, jota voidaan hyödyntää kehitettäessä tehohoitopotilaiden hoidon laatua sekä teho-osastolla että jälkiseurannassa.

In research, the transition from foster care to adult life has been pointed out as a significant and problematic period in young people´s lives. However, we know less about how this transition is handled professionally. Through qualitative interviews, this study examines social worker´s views and experiences of this transition process. The research questions focus on what needs social workers see in young people´s transition, how they describe their own work, and what strategies and tools that may promote the transition. The results are analyzed using the following theoretical concepts – discretion, emotional support, informative support,instrumental support and evaluative support. The study shows that young people need long-term relationships, certain practical skills and each type of support. Work with the transition is based on these needs. Here, social workers have an exploratory and coordination role thatconsists of many tasks. While they describe some specific strategies and tools, the results show that there are difficulties within this work. The roles of foster carers and social workers in young people´s transition to adulthood are discussed.

Introductions: The research deals with the attachment theory at women and min with substance use disorder in an aftercare programme. It is divided into theoretical and practical part. The theoretical part explains the concept of attachment, describes its theoretical foundations, the connections between attachment and addiction, the possibilities of therapeutic work with attachment, its application in work with people with addiction, gender differences and the specifications of aftercare programmes. The practical part is base on qualitatively oriented research. The research was conducted on interviews with ten respondents, five women (set A) and five men (set B). All respondents are people with SUD, currently abstinents, after addiction treatment, participating in an aftercare programme. Aim: The aim of the research was to compare the differences and similarities at men and women with addiction disorder in their attachment, partnerships and family relationships and the subsequent implications of the results for practical use. Methods: Two semi-structured clinical interviews, the Adult Attachment Interview (AAI) and the Current Relationship Interview (CRI), were used for the data generation. AAI is focused on childhood and early relationships between the respondent and his parents, CRI is focused on...

The susceptibility of adolescents to chemical addiction has become a major international concern. Approximately 25% of people in Central Asia and Eastern Europe who inject chemical substances are under the age of 20 years (Youth at the United Nations, 2006), while up to 75% of unintentional injuries among adolescents in America are related to substance abuse (Page & Page, 2003:196). On the national level, approximately 25% of adolescents under the age of 20 are involved in substance abuse (Western Cape Department of Social Services and Poverty Alleviation Transformation Plan, 2006:13). Focusing on the Western Cape, a report from the South African Epidemiology Network (2007:3) highlights that the youngest patient in in-patient treatment was nine years of age, and among 2 798 persons who received in-patient treatment, 27% were under the age of 20, more than any other age group in treatment. Treatment of adolescent chemical addiction should include preparation for treatment, treatment, and also aftercare services to ensure that the addicted adolescent develops skills to maintain sobriety (Meyer, 2005:292-293). Section Six of the South African Prevention and Treatment of Drug Dependency Act (1992) prescribes that chemically addicted persons should have access to professional aftercare services to ensure that treatment is not terminated prematurely. The motivation for this study was based on the fact that, despite this statutory requirement, the Western Cape Drug Forum (2005:3) identified the need for the development of aftercare services in 2005, indicating the lack of focus on aftercare as part of treatment. This concern was confirmed by practitioners in the field of adolescent chemical addiction and findings resulted from previous research regarding relapse experiences of chemically addicted adolescents (Van der Westhuizen, 2007:129-130). / Social Work / D. Phil. (Social Work)

Drug abuse is a very common problem these days; and this problem is especially rampant among the young people of South Africa. Early problems in family management, the antisocial behaviour of the child, and peer pressure and rejection ignite the early onset of substance abuse. Treatment programmes and therapeutic methods to treat chemical dependency are available and utilised, but the high relapse rate and lack of support from family members and dysfunctional families, as well as the fears and challenges expressed by in-patient youth about being reintegrated with their families and a lack of supporting literature in this regard remain a cause for concern and need to be considered by the social work profession in order to plan effective intervention strategies. In response to this situation a research project was undertaken with the purpose of exploring and describing the perceptions, expectations, fears and needs of chemically dependent youth in a rehabilitation centre about being integrated into their family systems in an attempt to forward recommendations to assist social workers in rendering effective therapeutic services to service users in rehabilitation centres who have a substance abuse problem. A qualitative approach was utilised following an explorative, descriptive and contextual research design. The study was conducted at an in-patient rehabilitation centre called the Dr Fabian and Florence Ribeiro Treatment Centre in Cullinan, Gauteng Province in South Africa. Data were collected by means of semi-structured interviews. A sample of participants was selected by using purposive sampling from a population of service users in the Dr Fabian and Florence Ribeiro Centre who are chemically dependent. Data were analysed according to the framework provided by Tesch (cited in Creswell, 2003). Guba‘s model (cited in Krefting, 1991) was employed for data verification. The research findings point to the fact that participants had both negative and positive perceptions about going back to their respective families. On the one hand, there were negative perceptions shared. These were founded on a feeling of worry about the fact that their families criticised them a lot or that their families would not accept that they had changed, would still treat them like addicts, and not trust them. Furthermore, they feared relapse, triggers in their environment and family members who were abusing a substance. On the other hand, some participants perceived the reintegration with their families, following treatment, in a positive light as they were looking forward to joining them again after being in v treatment for three months.They were excited about the fact that they had been granted an opportunity where they could show their families that they have changed and have the chance of starting a new life. Moreover, part of the research findings point to the fact that some of the participants‘ families had already organised employment, a place for them to stay and financial assistance. From the research findings it became clear that the participants harboured the following expectations towards the families with whom they were reuniting: They need the family‘s love and support; to trust them again: to mend severed relationships and spend quality time together; to provide practical and material help, and for the family to be educated on addiction and for the family to accompany them to aftercare. In terms of research findings directed at the site (i.e., the rehabilitation centre) where the research was conducted the participants indicated that they needed more activities, they would like their families to be part of their recovery process, and expressed the need for individual sessions apart from group sessions and aftercare services. In terms of recommendations it was apparent that community members, community organisations and the government sector need to develop and launch chemical substance abuse prevention and awareness programmes through various media, (i.e. articles in newspapers, magazines, talks and documentaries on radio and television, community gatherings and meetings in all communities). Moreover, it is recommended that parents should take responsibility for monitoring and countering substance abuse in their children. Families need to be empowered through talks, attending parenting skills training, workshops and group meetings. South Africa needs to develop a policy focusing on families. Furthermore, it is recommended that treatment centres need to provide individual sessions, family therapy, aftercare services and more extramural activities, if these are not included in their treatment regime. / Social Work / M.A. (Social Science)