Sibling relationships are an important, yet under investigated aspect of foster care research. Despite the fact that between 65-85% of children in care have brothers and sisters, only recently have child welfare researchers begun to explore the complex and dynamic nature of sibling relationships in substitute care settings. Although cross-sectional and longitudinal studies suggest differences in placement stability and permanency outcomes for siblings placed together versus those placed separately, the conditions under which sibling relationships influence placement stability, permanency, and well-being in foster care settings remain unknown. This dissertation investigated how family dynamics and home setting characteristics influenced the likelihood of a foster care placement change for a sample of children who participated in a sibling relationship enhancement intervention (SIBS-FC) study. A conceptual model was proposed to help explain the circumstances which lead to foster care placement change, and the moderating effects of family living composition on the odds of placement change over an 18-month period were examined. Two multivariate statistical approaches were used in this investigation. The first approach involved examining the effects of a child's report of positive home integration, sibling relationship quality, caregiver's reported impact of child behavior, sibling living situation, kinship caregiver status, number of placements prior to study entry, and receipt of the SIBS-FC intervention on the odds of placement change. Results suggest that children in kinship care were 58% less likely to experience placement change than those who lived in non-relative care, and youth who lived apart from their siblings were 70% more likely to experience placement change than those who lived together. In the second statistical approach, living composition categories were constructed to understand the moderating effects of different living situations on the odds of placement change. Living composition categories included youth who lived in kinship care with their siblings, youth who lived in kinship care without their siblings, and youth who lived in non-relative care with their siblings, with youth in non-relative care who lived apart from their siblings serving as the referent category. Findings support a moderation effect for different categories of living composition, as well as a trend level effect for sibling relationship quality and odds of placement change. Living with one's sibling in kinship care decreased the odds of placement change by 75%, as compared to living apart from one's sibling in a non-relative foster home. A post-hoc analysis determined that all living composition categories were statistically different from one another in relative odds of a placement change. This dissertation provides additional evidence concerning the protective nature of kinship care and sibling co-placement on reducing the odds of experiencing a foster care placement change, and provides support for practices and policies prioritizing kinship care and the co-placement of siblings when making substitute care placement decisions. Future studies of siblings in foster care should explore the experiences of youth across the different forms of foster care living composition, examine the relationship between placement stability and permanency outcomes, and examine the relationship between placement stability, permanency, and child well-being.

More than 5 million Americans have heart failure, with approximately 5% of those affected being veterans. As the number of patients with CHF continues to rise, new treatment options are needed to improve the quality of care. Current studies show Telehealth is one treatment option. The purpose of this scholarly project was to determine if veterans diagnosed with CHF were able to maintain optimal weight and blood pressure following participation in Care Coordination Home Telehealth (CCHT) program. The CCHT program provides care to veterans, through the use of monitoring devices placed in their home. Bandura's self-efficacy theory was used as a guide to develop veterans' self-management skills. A retrospective chart review was conducted on 26 veterans with CHF enrolled in the CCHT program. Post participation weight and blood pressure were analyzed at 16 weeks to determine whether there was a difference from the pre-participation measures. There was no change in systolic blood pressure, diastolic blood pressure, or weight levels during the 16-week period. Limitations of this project were the small sample size (n = 26), attrition rate (n = 43), no data on nurse interaction, and a short follow-up period. Implications for nursing practice and enhancing the program's efficacy are recommended. This scholarly project has the potential to support social change by expanding veteran's access to care.

Thesis (M.ED (Continuing care and Training)) --University of Limpopo, 2010. / This report describes the research conducted at Phuthanang Home Based Care in Mankweng Township in the Limpopo Province of South Africa. Mankweng constitute a mixture of both formal and informal settlements, both urban and rural settlements and is situated about 32 km to the east of Polokwane which is the provincial capital for Limpopo. The aim of the research was to investigate the challenges faced by Phuthanang Home Based Care (HBC) in providing care and training in Mankweng Township. Having established the challenges faced by Phuthanang Home Based Care the researcher intended to recommend possible solutions to these problems. In an attempt to meet the above mentioned aims; the following research questions were formulated: Main question: • What are the challenges faced by Phuthanang Home Based Care in providing care and training? The following sub questions were asked derived from the main question above: • What are the aims and objectives of Phuthanang Home Based Care? • What are the existing services and training programmes offered by caregivers at Phuthanang Home Based Care? • What are the experiences of caregivers in relation to training for Home Based Care? • What is the level of community participation in Phuthanang Home Based Care activities? Chapter two outlines the theoretical framework based on relevant literature on the subject under study. I also formulated assumptions about the challenges that could be facing home based care programmes; these include issues such as lack of funds, inadequate training and stigmatisation among others. In this chapter key concepts were defined and operationalised to suit this research and to avoid ambiguity in interpretation. Chapter three outlines the research methodology. It clearly explains the research design used, data collection and data analysis. This study was purely qualitative and took the form of a single case study design. This enabled a detailed and intensive study of the case as it exists in its natural setting. Data was collected according to two streams which are fieldwork and document analysis. In fieldwork the researcher used multiple data collection techniques which include open ended interviews with the Project Coordinator, Administrator and Caregivers. The other technique used was observations. A focus group interview with the Coordinator, Administrator and four caregivers was also employed during fieldwork. A data matrix was used in the analysis of data. Chapter four constitutes the presentation and analysis of findings of the study. In this chapter; I describe the setting of the organisation in terms of location, historical background as well as its aims and services rendered. It outlines the challenges encountered by Phuthanang Home Based Care in providing care and training based on the results from document analysis, interviews, observations and focus group interview with the Caregivers’, the Administrator and the Coordinator of Phuthanang Home Based Care. The findings will suggest recommendations that will help bolster the state of care giving, training, and improve the way care is rendered to people living with HIV/AIDS and other terminal illness. Chapter five presents my conclusions by outlining the challenges faced by Phuthanang Home Based Care in providing care and training. This chapter also presents recommendations that might contribute towards finding solutions to the problems faced by Phuthanang Home Based Care. After the recommendations I presented a section on reflections of the research process. In conclusion to this chapter I recommend further research on the challenges faced by home based care organisations which have an element of training in poor communities such as townships, informal settlements and rural areas.

Orientador: Maria Cristina Pereira Lima / Resumo: Trata-se de pesquisa qualitativa na qual se identificou, descreveu e analisou, a partir da percepção de profissionais de saúde de serviços de Assistência Domiciliar (AD), o conjunto de competências relacionais por eles empregadas, com ênfase na apropriação por parte do profissional e relevância para construção do vínculo terapêutico no contexto domiciliar. Foram realizadas entrevistas semi-estruturadas com oito membros de dois serviços de AD, do total de quatro do município de Campinas/SP, compondo-se amostra intencional de cinco diferentes categorias entre as 11 atuantes. Procedeu-se a análise de conteúdo desse material, segundo o referencial de Bardin, estabelecendo-se categorias analíticas. Os resultados demonstraram seis competências relacionais identificadas, sendo atitude empática considerada a mais importante, e as demais: conhecimento técnico, comunicação, gestão do cuidado, delimitar papel profissional, promover autonomia. A importância do vínculo e também seu caráter terapêutico foram referidos com destaque pelos entrevistados. Todas as competências foram apreendidas no contato com os serviços de AD, pacientes e famílias atendidas, e a partir dos colegas; processo esse que sensibilizou os profissionais para princípios da atenção integral à saúde. Foi relatado interesse em aperfeiçoar competências para manejo psicológico e cuidados paliativos. Concluiu-se que o desenvolvimento e aplicação dessas competências é essencial em AD, embora isso não tenha sido contemplado n... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: It is a qualitative research in which the set of relational competences they employ was identified, described and analyzed, from the perception of health professionals of Home Care services (HC), with emphasis on the appropriation by the professional and relevance for the construction of the therapeutic bond in the home context. Semi-structured interviews were carried out with eight members of two HC services, from a total of four in the municipality of Campinas/SP, making up an intentional sample of five different categories among the 11 participants. The content analysis of this material was made, according to Bardin’s framework, establishing analytical categories. The results demonstrated six relational competences identified, being empathic attitude considered the most important, and the others: technical knowledge, communication, care management, delimit professional role, promote autonomy. The importance of the bond and also its therapeutic character were highlighted with emphasis by the interviewees. All competences were learned in contact with the HC services, patients and families assisted, and from colleagues; this process made professionals aware of the principles of comprehensive health care. Interest in improving competences for psychological management and palliative care has been reported. It has been concluded that the development and application of these competences is essential in HC, although this has not been contemplated in professional training or techni... (Complete abstract click electronic access below) / Mestre

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Home programs are widely used by occupational therapists as a strategy to address health and development needs of children with cerebral palsy. Experts believe they are essential. Despite wide-spread clinical use there is no high quality research evidence proving home program effectiveness. Further there is no information that provides a parent perspective on home programs. The aim of this research was to evaluate the effectiveness of occupational therapy home program intervention for school-aged children with cerebral palsy and identify factors perceived to be important in home program practice from a parent perspective. A double blind randomised controlled trial design was used to evaluate effectiveness, where parents and evaluators were blinded to intervention. Children were randomised to three groups, home program intervention for eight weeks (“8WEEKS”), home program intervention for four weeks (“4WEEKS”), and a control group, that did not receive home program intervention (“NoHP”). The primary end-point was change in performance of functional activities and satisfaction with function as measured by the Canadian Occupational Performance Measure (COPM), after eight weeks. Secondary endpoints were change in COPM scores after four weeks, goal achievement at four and eight weeks as measured by Goal Attainment Scale (GAS), quality of arm movement at four and eight weeks measured on the Quality of Upper Extremity Skills Test (QUEST) and participation levels at four and eight weeks measured on the Children’s Assessment of Participation and Enjoyment (CAPE). Parent experience was explored through semistructured interviews of parents who participated in the home program trial. Content analysis of interview data was conducted to the level of “open coding” to identify factors. Results for the primary outcome measure at the primary end point (eight weeks) - Effect of an 8WEEK or 4WEEK home program on COPM scores: comparison between the three groups was conducted using a linear regression model with baseline COPM performance/satisfaction scores, participant age and severity of cerebral palsy as measured by the GMFCS entered into the model as covariates. Overall, there were statistically significant and clinically important differences in performance of activities and satisfaction with function on COPM when comparing either home program group to the NoHP group at eight weeks. There was no difference between 4WEEKS versus 8WEEKS on COPM performance or satisfaction scores at eight weeks. Results on secondary outcome measures: compared to NoHP, receiving a home program for either 4WEEKs or 8WEEKs increased COPM performance scores and GAS measures at four weeks, and increased COPM performance and satisfaction scores, GAS measures, and QUEST scores at eight weeks. There were no differences within or between groups on the CAPE at either four week or eight weeks. There were no statistically significant between-group differences between the 4WEEK and 8WEEK home program groups on any secondary outcome measures. This was most likely the result of a protocol implementation flaw that occurred in the study where 4WEEK group participants continued program activity for the final four weeks when they should have suspended it. Parents perceived their experience of implementing home programs as characterised by five features: ����guidance for the journey”, practice makes perfect, they were a necessary “way of life”, they maximised progress and something that made it easier to juggle competing demands. Positive home program experiences were characterised by: support, realistic expectations, flexibility, motivation from goals, activities that translated to real-life, reminders to practice, progress updates and role clarity. Parents advised other parents to: accept the disability, never refuse help, be honest, consider home programs essential, develop routines and view programs as a way of improving the child and parents’ life. No negative experiences were reported. Parents advised professionals that they wanted: support, interdisciplinary co-ordination of programs, advice without pressure and prognostic guidance for future planning. This dissertation presents new information about occupational therapy home programs. Until this study, there was little research evidence to inform therapist or parent decision-making regarding the therapeutic value of home programs or the parent perspective on home programs. Findings from this dissertation can inform clinical practice and parent decisions regarding the use of home program interventions for children with cerebral palsy. / Doctor of Philosophy (PhD)

Master of Social Work / This research is about evidence based practice, which is an area of increasing interest and emphasis in social work today. Initially apparent in medical and health care settings, evidence based practice now has widened applicability to a broad range of contexts and professional disciplines. The ways in which research evidence is translated into policy and practice is itself a topic area for social work research. The study investigates evidence based practice in child welfare, specifically the out-of-home care system. Out-of-home care provides alternative placements for children and young people who cannot live with their families because of abuse and neglect, and generally consists of placement with foster carers or in a residential/group care setting. This research is an exploratory study which investigates through individual interview how nineteen out-of-home care Senior Managers and Team Leaders in the states of New South Wales, Western Australia and the Australian Capital Territory interpret and understand evidence based practice, and the degree and depth of knowledge they transfer from research awareness into out-of-home care practice and policy development. The research has three main objectives. Firstly to investigate the understanding of out-of-home care managers of evidence based practice, secondly to determine the influence of relevant research on practice and policy in out-ofhome care, and thirdly to explore potential barriers to evidence based practice. Looking After Children, a social work case management system for children and young people in out-of-home care, provides the context for this research, in which evidence based practice is critically examined. A thematic analysis of the interview data identified five major themes. These included: the benefit of broadening definitions of evidence based practice to include a wide range of influences on practice; the value and importance of 2 considering a broad range of research approaches in connecting research with policy and practice AND the potential for influencing outcomes of social work intervention via research based and influenced guided practice systems and techniques; factors which constitute barriers and also those that enhance the implementation of evidence based practice; the potential for instigating and supporting new research via the use of evidence based practice for purposes such as data aggregation, in addition to practice development and enhancement of client outcomes. Implications and conclusions are drawn from this study in relation to out-ofhome care policy and practice, with particular reference to use of the Looking After Children case management system in the Australian context. These include the potential of a consistent system such as LAC to provide common language and assessment tools and procedures in a welfare sector that is fragmented by lack of national legislation, and the potential for development of national out-of-home care research projects as a result of cross agency LAC implementation resulting in data aggregation opportunities.

One of the major challenges currently being faced by out-of-home care services is the issue of placement breakdown and multiple placements, and the psychological effects of these experiences. Previous longitudinal research by Barber and Delfabbro (2004) indicates that approximately 15-20% of young people in Australian out-of-home care have significant emotional and behavioural problems or 'high support needs' that often condemns them to a life of repeated placement instability and further psychosocial harm. This thesis reports the findings of Australia's first national comparative study of 364 children with this placement profile in four Australian States (Queensland, South Australia, Victoria and Western Australia). Based on detailed interviews with case-workers, case-file reading, and comprehensive analysis of objective placement data, this study provides a detailed analysis of the social and family background of this population of children, their psychosocial profile, service history, and their placement experiences. It was found almost all of the children with high support needs in Australian out-of-home care had been subjected to traumatic, abusive, and highly unstable family backgrounds. A proportion of young people had experienced over 30 placement changes and approximately 70% scored in the clinical range of emotional and behavioural disturbance. The young people in the sample were generally very similar in their characteristics. Children within this population appear to form one single cluster based upon very common family experiences; namely, the combined effects of domestic violence, substance abuse, physical violence and neglect. Such findings suggest very strongly that out-of- home care policy cannot, and should not, be considered in isolation from other important areas of social policy and public health. Following the review of the characteristics of the children, the thesis examined the range of therapeutic interventions and placement options that might be suitable to address their needs. This section involved a literature review, an extensive internet search of care and service options and a review of program information wherever this was available. It is clear from the review that it is very difficult to maintain this population of children and young people in stable family-based foster care arrangements within the existing out-of-home care system. This thesis highlights the need for a greater integration of services and a greater focus on ensuring an ongoing commitment to addressing the entrenched psychological and social difficulties contributing to placement instability. There is also a great need for a re-structuring and re-thinking of the continuum of care services available to children in out-of-home care, including the possible development of professional foster care services and an increased use and availability of treatment group residential care options. Most importantly, a re-structuring of the way child protective services and family, social and mental health services are provided and coordinated by State governments is felt to be desperately needed. / Thesis (Ph.D.)--School of Psychology, 2006.

This research examines interventions with adolescents in out-of-home care diagnosed with severe conduct disorder. Interventions from the service sectors of mental health, juvenile justice, child protection and welfare are reviewed and discussed. The research centred around three hypotheses. Firstly, that adolescents in out-of-home care diagnosed with severe conduct disorder have poor treatment outcomes. Secondly, that adolescents in out-of-home care diagnosed with severe conduct disorder are a particularly difficult client group to work with because of issues of attachment. Thirdly, that a diagnosis of severe conduct disorder negatively impacts upon the work professionals undertake with these young people. These hypotheses were considered in the context of an extensive literature review as well as findings gleaned from interviews and questionnaires conducted with research participants drawn from the abovementioned service sectors. Research participants were senio r practitioners and managers with many years of practice and experience working with adolescents in out-of-home care diagnosed with severe conduct disorder. The main findings from the research were that all three hypotheses appeared to be supported. These were that adolescents in out-of-home care diagnosed with severe conduct disorder have poor treatment outcomes and that one of the particular difficulties of working with this client group is the issue of attachment. Also, that the diagnosis of severe conduct disorder negatively impacts upon the work professionals undertake with these young people. These findings are discussed within the theoretical frameworks of attachment theory and critical theory, which are utilised in exploring the alienation and oppression of these young people on intrapersonal, interpersonal and societal levels. Finally, implications for social work research and practice are considered.

Thesis (Ph. D.)--University of Missouri-Columbia, 2007. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on December 12, 2007) Vita. Includes bibliographical references.