Implementation of the Community Homes for Opportunity Program Among Community Mental Health Staff in Southwestern Ontario.

Supportive housing programs such as the Community Homes for Opportunity (CHO) that provide combined formal (off-site healthcare providers) and informal (on-site supports are effective in reducing erratic housing and homelessness. This study explored the views of the Community Mental Health Agency staff on their experiences with the CHO and related changes for further improvement of the program. We applied focused ethnographic techniques to recruit 47 agency staff from 28 group homes in Southwestern Ontario, Canada. Focus group discussions were conducted at two-time points (baseline-spring 2018 and post-implementation - winter 2019). Data analysis guided by Leininger's ethnographic qualitative analysis techniques produced three main themes and 11 subthemes themes. The main themes include facilitators of CHO, challenges to the CHO implementation, and strategies for improving the CHO program. Overall, supportive housing models have been found to constitute an effective pathway to reducing precarious housing and ending chronic homelessness for those in need while enhancing their social integration.

Improving the mental health of abandoned children: Experiences from a global online intervention.

In today's world of global migration and urbanization, millions of children are separated from parents. Their mental health and future competences as citizens depend on the quality of care from foster parents and group home staff in nonparental care settings. Caregivers are challenged by poor work conditions, too many children, and a lack of knowledge about care for traumatized children. How can our profession match this challenge by upscaling interventions? Digital designs for applications of psychology are growing, recently accelerated by the COVID-19 crisis. From 2008, the author developed a blended learning intervention. In partnerships with nongovernmental organizations and government agencies, care recommendations from an international network of researchers are transformed into start-up seminars for staff, followed by a 6-month online classroom education. Students learn and practice how to train local caregiver groups in attachment-based care, using training sessions developed in local languages, adjusted to culture. At present, the author's Fairstart Foundation educated 500 staff from partners in 26 countries, who have trained the caregivers of some 40,000 children. The theoretical, logistic and technical steps from research to daily caregiver-child practices are described, to inspire discussions of how online designs and international partnerships may benefit underserved populations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Residents' and resident representatives' perspectives on the influence of the organisational environment on challenging behaviour.

BACKGROUND: This study explored the perspectives of residents of residential disability service organisations and resident representatives on the influence of the organisational environment on challenging behaviour in people with intellectual disabilities (ID). METHOD: Sixteen residents and representatives from four specialised Dutch disability service organisations were interviewed. Data were analysed using a grounded theory approach, with a sensitising frame based on Bronfenbrenner's ecological theory. RESULTS: Some organisational factors (e.g. staff turnover, insufficient finances) can have negative effects on interactions among residents and staff and family members, resulting in more challenging behaviour, but other organisational factors (e.g. shared vision, values and expectations, competent staff) can positively influence staffs' attitudes and actions, which in turn helps to manage challenging behaviour in people with ID. CONCLUSIONS: Residents' and representatives' perspectives provide a better understanding of the positive and negative influences of the organisational environment on challenging behaviour in people with ID.

Public health should promote co-operative housing and cohousing.

In promoting healthier built environments, attention worldwide has focused largely on streetscapes and recreational spaces, with less regard given to housing form, in particular to the health effects of communal housing. Research demonstrates that communal housing models, such as cohousing and co-operative housing, promote social inclusion, and increase the perceived well-being and mental and physical health of residents, particularly of seniors. In Canada, relative to other countries, there is a paucity of evidence for the health effects of co-operatives and cohousing. Historically, some Indigenous communities constructed longhouses, connected dwellings situated around common areas, a form which may still be useful in promoting healthy communities. In this commentary, we suggest that improving access to co-operative and communal housing is an important area for public health involvement.

Staff views on member participation in a mental health clubhouse.

The clubhouse model is a community psychiatric rehabilitation program aiming to provide a restorative environment for people with severe mental health problems. These clubhouses provide their members with opportunities for friendship, employment, and education, which help them on their paths towards mental health recovery. Towards that end, the model features clubhouse members and staff working side by side to execute clubhouse activities. That is, unlike most of the community mental health programs where staff provide services to their clients, clubhouse staff are required to partner with members in their work. The aim of this qualitative study was to understand how the clubhouse staff elicited member participation and facilitate recovery. The research was conducted between Year 2013 and Year 2014 at the world's first clubhouse: Fountain House in New York City. The first author conducted 262 hr of active participant observation in 41 visits to Fountain House, and in-depth interviews with 38 staff members who had worked at Fountain House for at least 1 month during the study period. The dimensional analysis procedure was used to analyse the observation notes and interview transcripts. Results showed that participation was a key to rebuilding members' self-confidence, which further encouraged members to seek more opportunities for self-enhancement and personal growth. Specific organisational policies, programming, practical considerations, and other strategies shaped a positive environment for members to exercise autonomy, experience self-efficacy, and model behaviours after others who have succeeded. Findings of this research support the egalitarian staff-member relationships and the maintenance of an open and transparent atmosphere of the clubhouse, as observational learning enables members to move forward with their journeys to recovery. Findings also may inform efforts to shift traditional psychiatric services towards recovery-oriented care.

Influence of the organizational environment on challenging behaviour in people with intellectual disabilities: Professionals' views.

BACKGROUND: We examined the influence of the organizational environment on challenging behaviour in people with intellectual disabilities to increase understanding of the quality of support services for people with intellectual disabilities. METHOD: Twenty-one professionals and managers from four specialized Dutch disability service organizations were interviewed. Data were analysed with a grounded theory approach, using Bronfenbrenner's ecological theory as a sensitizing frame. RESULTS: The organizational environment (i.e., vision, values, sufficient resources) is related via the support service (i.e., providing stability, constant awareness) to residents' challenging behaviour and is also linked directly to challenging behaviour (e.g., living environment, values). Organizations are restricted by national regulations, negative media attention and changing societal values, which negatively influence quality of support. CONCLUSIONS: The creation of a supportive organizational environment for staff, who in turn can provide quality support services to residents with demanding care needs, was found to prevent challenging behaviour in people with intellectual disabilities.

Caring and Uncaring Encounters between Assistant Nurses and Immigrants with Dementia Symptoms in Two Group Homes in Sweden-an Observational Study.

BACKGROUND: The total number of people with dementia symptoms is expected to double every 20 years and there will also be an increase in the number of older immigrants in several countries. There are considerable deficiencies in the present knowledge of how to conduct well-functioning health care for immigrants with dementia symptoms. The aim of this study was to explore caring and uncaring encounters between assistant nurses and immigrants in two group homes for persons with dementia symptoms in Sweden: a Finnish-speaking as well as a Swedish-speaking context. In addition, this study aims to describe how caring and uncaring encounters are manifested in these two contexts according to Halldórsdóttir's theory of "Caring and Uncaring encounters". METHOD: Descriptive field notes from 30 separate observations were analyzed using qualitative deductive content analysis. RESULTS: The main category "caring encounters" focused on reaching out to initiate connection through communication, removing masks of anonymity by acknowledging the unique person, acknowledgment of connection by being personal. Reaching a level of truthfulness by being present and showing respect, raising the level of solidarity by equality and true negotiation of care, based on the residents' needs. The main category, uncaring encounters, focused on disinterest in and insensitivity towards the other, coldness in the connection and lack of humanity in care situations. The observations showed that caring encounters occurred more in the Finnish-speaking context and uncaring encounters more often in the Swedish context. CONCLUSION: Encounters could be caring, uncaring, and carried out using a person-centered approach. Communication and relationships could be facilitated using the same language but also through learning to interpret residents' needs and desires.

How frontline staff manage paperwork in group homes for people with intellectual disability: Implications for practice.

BACKGROUND: Paperwork is a key tool that transforms organizational intentions into actions in group homes, although prescriptive procedures may limit how frontline staff use it in practice. The aim of this study was to explore how frontline staff use paperwork in group homes for people with intellectual disability and identify practice implications. METHOD: Constructivist grounded theory methodology guided the research. Data collection included semi-structured interviews and participant observations. Coding, comparison and sorting methods were adopted to analyse how staff used paperwork. RESULTS: Staff followed organizational paperwork rules when they aligned with their resident-focused approach to work. When they perceived rules to misalign with this approach, they managed paperwork by adjusting the time and place of completion, managing content, creating alternative tools and refusing completion. CONCLUSIONS: Staff purposefully managed paperwork rather than simply following procedures. Disability service organizations could develop flexible paperwork procedures and include frontline perspectives in paperwork development.

Training for Direct Support Staff at Group Homes for People with Chronic Mental Illness.

For people with chronic mental illness, their support system (including direct support staff at group homes) play a key role in ameliorating exacerbations leading to crisis care. However, little information exists on curriculum or training programs focused on reducing exacerbations while promoting compassionate care. We developed, implemented and evaluated such a program that featured role-playing and animated videos supplemented with limited didactics. During development phase, direct support staff reviewed videos and rated them as depicting realistic situations with high acceptability. During implementation, the 6-week course (at least one staff from six different group homes not involved in the development phase) using a 3-month pre-post design found reductions in total number of incident reports and pre-specified outcomes of recipient right complaints, emergency calls, and psychiatric hospitalizations. The program demonstrated acceptability, improved care and better outcomes on some but not all outcomes. Improved training of direct support staff is possible and has positive outcomes.

Supported housing for adults with psychiatric disabilities: How tenants confront the problem of loneliness.

The objective of this study was to examine the experience of loneliness among people with psychiatric disabilities after moving from custodial housing, including group homes, boarding homes, and family-type residences to independent, supported apartments in the community. Qualitative research methods guided by a naturalistic/constructivist framework were used. Data collection occurred between May 2014 and July 2015 and consisted of individual semi-structured interviews with 24 tenants residing in five supported housing sites across three Canadian provinces; interviews were also conducted with a designated family member for each tenant and with their service providers. Group interviews were conducted with housing workers in the five housing sites. The interviews were transcribed verbatim, codes generated and a thematic analysis undertaken using a constructivist approach. Results showed that for most tenants living in independent apartments with support loneliness was not a serious problem or was an issue that could be overcome. Most study participants viewed supported housing as preferable to custodial housing and as a normalising experience that facilitated community integration. While housing conditions, particularly those associated with congregate housing, sometimes helped attenuate loneliness among tenants, managing loneliness was primarily contingent on the ability of individuals to develop and maintain social connections, as well as on family involvement.

Understanding the implementation of maternity waiting homes in low- and middle-income countries: a qualitative thematic synthesis.

BACKGROUND: Maternity waiting homes (MWHs) are accommodations located near a health facility where women can stay towards the end of pregnancy and/or after birth to enable timely access to essential childbirth care or care for complications. Although MWHs have been implemented for over four decades, different operational models exist. This secondary thematic +analysis explores factors related to their implementation. METHODS: A qualitative thematic analysis was conducted using 29 studies across 17 countries. The papers were identified through an existing Cochrane review and a mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and barriers and facilitators for implementation. The influence of contextual factors, the design of the MWHs, and the conditions under which they operated were examined. RESULTS: Key problems of MWH implementation included challenges in MWH maintenance and utilization by pregnant women. Poor utilization was due to lack of knowledge and acceptance of the MWH among women and communities, long distances to reach the MWH, and culturally inappropriate care. Poor MWH structures were identified by almost all studies as a major barrier, and included poor toilets and kitchens, and a lack of space for family and companions. Facilitators included reduced or removal of costs associated with using a MWH, community involvement in the design and upkeep of the MWHs, activities to raise awareness and acceptance among family and community members, and integrating culturally-appropriate practices into the provision of maternal and newborn care at the MWHs and the health facilities to which they are linked. CONCLUSION: MWHs should not be designed as an isolated intervention but using a health systems perspective, taking account of women and community perspectives, the quality of the MWH structure and the care provided at the health facility. Careful tailoring of the MWH to women's accommodation, social and dietary needs; low direct and indirect costs; and a functioning health system are key considerations when implementing MWH. Improved and harmonized documentation of implementation experiences would provide a better understanding of the factors that impact on successful implementation.

State strategies for coordinating Medicaid and housing services.

OBJECTIVE: This article reports findings from case studies of 4 states (Illinois, Louisiana, Massachusetts, and Tennessee) that used different approaches to coordinate Medicaid services with temporary or permanent housing supports for individuals with psychiatric disabilities. METHOD: Data were collected through document review, telephone interviews with state officials and managed care organizations, and site visits to behavioral health and housing providers, and consumer organizations. Qualitative analyses focused on identifying key features of each state's approach, including the strengths and limitations from multiple perspectives. RESULTS: All 4 states facilitated partnerships between behavioral health and housing providers. Each state used managed care strategies to some degree and identified opportunities to use Medicaid to finance the coordination of services with housing providers. These financing strategies included using flexible case rates to fund community support workers; using a 1915(i) state plan amendment to fund intensive Medicaid behavioral health services for those in permanent supportive housing; funding new local entities to support local partnerships between health and housing organizations; and creating a Medicaid supportive housing benefit. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These 4 states took advantage of the flexibility that Medicaid offers to implement different service models in an effort to improve the coordination of behavioral health services and housing. The strategies used in these states may be useful to other states and communities seeking to strengthen coordination of care for individuals who require housing support. (PsycINFO Database Record

El segundo hogar de las familias, la Casa que cuida a los niños enfermos / No disponible

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Formative evaluation on a physical activity health promotion program for the group home setting.

Physical inactivity and high rates of chronic conditions is a public health concern for adults with intellectual disability. Few health promotion programs target the group home setting which is the pre-dominant form of residential accommodation for persons with intellectual disability. A process evaluation of a physical activity health promotion program, Menu-Choice, was conducted with five group home sites for adults with intellectual and developmental disabilities. Menu-Choice assists group home staff in including physical activity goals within resident schedules. The physical activity program was designed based on theoretical frameworks, community-based participatory approaches, and established health promotion guidelines for adults with disabilities. Fourteen program coordinators (age M 39; 77% females), 22 staff (age M 39; 82% females), and 18 residents (age M 59; 72% females; 56% ambulatory) participated. Results from the fidelity survey and program completion highlight potential challenges with implementation. Findings will assist with the refinement of the program for continued implementation trials in the group home community.

Immigrants with dementia in Swedish residential care: an exploratory study of the experiences of their family members and Nursing staff.

BACKGROUND: Worldwide, there is a growing population of older people who develop dementia in a country other than that of their origin. When their dementia has reached an advanced stage, residential care is most often needed. People with dementia in Sweden are often cared for in group homes. For immigrants, this may mean a linguistically challenging care environment for both healthcare staff and the patients' family members. The aim of this study was to explore and describe the experiences of family members and professional caregivers regarding the care provided to immigrants with dementia in group homes in Sweden. METHODS: An exploratory, descriptive study with a qualitative approach was chosen. In-depth semi-structured interviews were conducted with nine professional caregivers and five family members of people with dementia with Finnish, Estonian, Hungarian and Ingrian backgrounds; all were chosen purposefully. All people with dementia had lost their Swedish language skills as their second language. The data was analysed using qualitative content analysis. RESULTS: Three main categories and seven subcategories were identified. The first main category: A new living situation comprised the subcategories: adjusting to new living arrangements and expectations regarding activities and traditional food at the group home, the second main category: Challenges in communication with the subcategories: limited communication between the immigrant with dementia and the Swedish-speaking nursing staff and the consequences of linguistic misunderstandings and nuanced communication in a common language and the third main category: The role of the family member at the group home with the subcategories: a link to the healthy life story of the family member with dementia and an expert and interpreter for the nursing staff. CONCLUSIONS: The family member played a crucial role in the lives of immigrants with dementia living in a group home by facilitating communication between the nursing staff and the PWD and also by making it possible for PWD to access the cultural activities they wanted and which professional caregivers were either not able to recognise as needed or could not deliver.

Value of Information Analysis Applied to the Economic Evaluation of Interventions Aimed at Reducing Juvenile Delinquency: An Illustration.

OBJECTIVES: To investigate whether a value of information analysis, commonly applied in health care evaluations, is feasible and meaningful in the field of crime prevention. METHODS: Interventions aimed at reducing juvenile delinquency are increasingly being evaluated according to their cost-effectiveness. Results of cost-effectiveness models are subject to uncertainty in their cost and effect estimates. Further research can reduce that parameter uncertainty. The value of such further research can be estimated using a value of information analysis, as illustrated in the current study. We built upon an earlier published cost-effectiveness model that demonstrated the comparison of two interventions aimed at reducing juvenile delinquency. Outcomes were presented as costs per criminal activity free year. RESULTS: At a societal willingness-to-pay of €71,700 per criminal activity free year, further research to eliminate parameter uncertainty was valued at €176 million. Therefore, in this illustrative analysis, the value of information analysis determined that society should be willing to spend a maximum of €176 million in reducing decision uncertainty in the cost-effectiveness of the two interventions. Moreover, the results suggest that reducing uncertainty in some specific model parameters might be more valuable than in others. CONCLUSIONS: Using a value of information framework to assess the value of conducting further research in the field of crime prevention proved to be feasible. The results were meaningful and can be interpreted according to health care evaluation studies. This analysis can be helpful in justifying additional research funds to further inform the reimbursement decision in regard to interventions for juvenile delinquents.

Meanings associated with the core component of clubhouse life: the work-ordered day.

Despite the clubhouse model's 60-year existence internationally, the central nature of its core program, the "work-ordered day" (WOH) (Beard et al. in Psychosocial Rehabilitation Journal 5:47-53, 1982), is not well understood; hence, the primary focus of the present study was to explore members' experiences of the nature and meaning of the WOH. The study drew on qualitative interview data collected in 2009-2013 through open-ended questions and probes with 102 members and 24 staff from 5 Clubhouse International-certified clubhouses (2 US and 3 Finnish). Participant observation supplemented the interviews and all data were analyzed using a grounded theory approach (Charmaz in Rethinking methods in psychology, 1995; Glaser and Strauss in The discovery of grounded theory: strategies for qualitative research, 1967). Two major themes clustered around: (a) WOH in service of autonomy (things to do, sense of accomplishment, respite, development of occupational skills) and (b) WOH in service of relationships (receiving support; collaboration; and making contributions to the clubhouse community). Clubhouse members appeared to experience the WOH as meaningful because it helps them, as its best, reconstruct a life, develop their occupational self and skill sets, and experientially learn and live what parallels a good life in the general community. It appears that these experiences, interconnecting with the fundamental human needs for autonomy and relationship, point to wellbeing and recovery as part of personal growth. These findings can guide clubhouse daily practice in assessing members' psychosocial strengths and needs pertaining to recovery. Future research should elaborate on influences of sources of meaning, including work designs and the contributions of everyday socio-cultural interactive and reciprocal processes to these meanings.

Improving the oral health of residents with intellectual and developmental disabilities: an oral health strategy and pilot study.

This article presents an oral health (OH) strategy and pilot study focusing on individuals with intellectual and/or developmental disabilities (IDD) living in group homes. The strategy consists of four components: (1) planned action in the form of the behavioral contract and caregiver OH action planning; (2) capacity building through didactic and observation learning training; (3) environmental adaptations consisting of additional oral heath devices and strategies to create a calm atmosphere; and (4) reinforcement by post-training coaching. A pilot study was conducted consisting of pre- and post-assessment data collected 1 week before and 1 week after implementing a 1-month OH strategy. The study sample comprised 11 group homes with 21 caregivers and 25 residents with IDD from one service organization in a Midwestern city. A process evaluation found high-quality implementation of the OH strategy as measured by dosage, fidelity, and caregiver reactions to implementing the strategy. Using repeated cross-sectional and repeated measures analyses, we found statistically significant positive changes in OH status and oral hygiene practices of residents. Caregiver self-efficacy as a mechanism of change was not adequately evaluated; however, positive change was found in some but not all types of caregiver OH support that were assessed. Lessons learned from implementing the pilot study intervention and evaluation are discussed, as are the next steps in conducting an efficacy study of the OH strategy.

Youth in group home care: youth characteristics and predictors of later functioning.

This paper presents the findings of an exploratory research study of foster care youth residing in group homes in a mid-Atlantic state in the USA. The aims of the present study were to (1) describe youth characteristics, (2) explore whether baseline functioning differed by gender or ethnicity, (3) explore predictors of cross-time differences in psychosocial functioning, and (4) explore predictors of later functioning, specifically age, gender, and length of stay. Psychosocial functioning at two time points (i.e., T1 = admission into group home; T2 = current or discharge) in 180 charts from 29 randomly selected group homes were reviewed. Youth were on average 14.86 years of age, predominantly male (71%; n = 128), and predominantly African American (79%). Findings suggest that group home placement may benefit some youth but not others, particularly girls and younger children with lower initial level of need. Findings underscore the potential complexity of intervention impact in the context of unique youth, family, and environment factors.