Care Arrangements (care + arrangement)

Distribution by Scientific Domains

Selected Abstracts

Children of Mothers Admitted to Psychiatric Hospital: Care Arrangements and Mothers' Perceptions

Judi Cunningham
This paper describes the care arrangements made for children when their mothers are admitted to psychiatric hospital. It also describes at admission, and at 3 months follow-up, the views and opinions of mothers and carers with regard to the admission, its impact on the family, and the service received. It was found that children are predominantly cared for within their family when their mother is admitted to hospital, and that mothers and carers are concerned about the impact of the admission and its associated problems. [source]

Managed Behavioral Health Care: An Instrument to Characterize Critical Elements of Public Sector Programs

M. Susan Ridgely
Objective. To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and ,unmanaged" care and among managed care arrangements. Study Design. The instrument was developed by a multi-institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers. Data Collection Methods. Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants. Principal Findings This instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care. Conclusions. If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary. [source]

Mothers' attachment representations and choice of infant care: center care vs. home

Nina Koren-KarieArticle first published online: 14 SEP 200
Abstract In the debate concerning the effects of day care on infant development, insufficient attention has been paid to the potential relationship between pre-existing emotional differences among mothers and the type of care they choose for their infants. To shed light on this issue, this study examines the attachment representations of mothers who choose day-care centres as opposed to mothers who choose to remain at home with their infants. Participants were 76 primiparous mothers. Mothers' attachment classifications were assessed by the Adult Attachment Interview [AAI; Main M, Kaplan N, Cassidy J. 1985. Security in infancy, childhood, and adulthood: a move to the level of representation. In Growing Points of Attachment Theory and Research. Monograph of the Society for Research in Child Development, 50, (1,2, serial no. 209), Bretherton I, Waters E (eds); 66,104]. Results indicate that more Day-care than Home-Care mothers are classified as insecurely attached. These results highlight the contribution of maternal emotional characteristics to the effects of diverse child care arrangements on infant development. Copyright 2001 John Wiley & Sons, Ltd. [source]

The Role of Social Support in Facilitating Postpartum Women's Return to Employment

Marcia Gruis Killien
Purpose: More than half of mothers with infants under 1 year are employed. This study explored the role of social support in facilitating women's return to employment during the 1st year postpartum. Design: Analysis of existing longitudinal, repeated-measures questionnaire data gathered at 4 and 12 months postpartum. Participants: 94 postpartum women who were married or partnered, employed, and residing in a large urban area in the northwestern United States. Outcome Measures: Satisfaction with decision to return to work, role performance, work-family balance. Results: Relationships between indicators of social support and return-to-work experiences were absent to modest. Satisfaction with child care was related to satisfaction with the decision to return to work. Workplace support was related to work-family balance at 12 months postpartum. Conclusions: Satisfactory child care arrangements and supportive relationships in the workplace are the most significant facilitators of women's return to work postpartum. [source]

Family Carers of Adult Persons with Intellectual Disabilities on the Island of Ireland

Steve Barron
Abstract, Many families provide lifelong support to their relative with an intellectual disability. However, relatively little information is available for national populations on the characteristics of the people for whom these families care and the supports they receive or need. A database of all persons in receipt of intellectual disability services has been operating in the Republic of Ireland since 1995 and records details of those living with family carers. In Northern Ireland, regional databases provide similar information. Using both sources, data were obtained on over 12,500 people living with family carers; half of whom lived with two parents, around 30% with a lone parent, and just under 20% with another relative. More people in Northern Ireland were identified as living with family carers, which was attributed mainly to less available residential alternatives. Only a minority of carers received respite breaks and domiciliary supports although higher proportions required them. The authors conclude that family care arrangements have received relatively little attention within government policy making, and hence service provision has been largely reactive. Future research should focus on the changing needs of carers over time and how they can be better supported in their role. [source]

Out-of-area placements in Scotland and people with learning disabilities: a preliminary population study

M. BROWN bsc (hons) msc pgce phd rgn rnld
People with learning disabilities have a different pattern of disease from the general population and high health needs that are frequently unidentified and unmet. Many require responses from general and specialist health services. A picture is emerging of some people with learning disabilities, often with complex care needs, moving from their home area on what is being termed, out-of-area placements, to receive specialist care. However, within the learning disability population, limited research has been undertaken and the impact on health services is unknown. Data were collected from health and social care providers to identify people with learning disabilities moving in and out of services across Scotland. Further data about the consequences and impact of out-of-area placements were gathered in one geographical area using focus group methodology. The results suggest that people with learning disabilities are moving in, out and across Scotland, often as a result of breakdown of local care arrangements or because of lack of specialist resources. Planning, service development and effective communication need to be in place to address the needs of this increasing and ageing population. [source]

Quality of Care After Early Childhood Trauma and Well-Being in Later Life: Child Holocaust Survivors Reaching Old Age

Elisheva van der Hal-van Raalte PhD
The link between deprivation and trauma during earliest childhood and psychosocial functioning and health in later life was investigated in a group of child Holocaust survivors. In a nonconvenience sample 203 survivors, born between 1935 and 1944, completed questionnaires on Holocaust survival experience and several inventories on current health, depression, posttraumatic stress, loneliness, and attachment style. Quality of postwar care arrangements and current physical health independently predicted lack of well-being in old age. Loss of parents during the persecution, year of birth of the survivors (being born before or during the war), and memories of the Holocaust did not significantly affect present well-being. Lack of adequate care after the end of World War II is associated with lower well-being of the youngest Holocaust child survivors, even after an intervening period of 60 years. Our study validates Keilson's (1992) concept of "sequential traumatization," and points to the importance of aftertrauma care in decreasing the impact of early childhood trauma. [source]

Peer and teacher ratings of third- and fourth-grade children's social behavior as a function of early maternal employment

Lise M. Youngblade
Background:, One of the more controversial issues related to maternal employment in the United States concerns the timing of entry into the workforce and its effect on children, particularly during the first year of the child's life. Some studies show deleterious effects on children, such as increases in aggression and noncompliance, while others document few negative and even positive effects of early employment. Methods:, This study examined the long-term effects of maternal employment during the child's first year of life on the social behavior of 171 third- and fourth-grade children in two-parent families. The moderating effects of child gender and social class were investigated. The extent to which stability in alternative care arrangements statistically explained links between early maternal employment and child outcomes was tested. Results:, After controlling for child gender, and maternal ethnicity, social class, and current employment status, third- and fourth-grade children whose mothers were employed during their first year of life evinced more acting out and less frustration tolerance and were nominated more often by peers for ,hitting' and ,being mean' than children whose mothers were not employed. There was some evidence that these associations were moderated by child gender and social class: boys, but not girls, whose mothers were employed during the first year were subsequently rated by teachers as acting out more than other children, and were also more likely to be nominated by peers for hitting. Higher nominations for hitting were only found in the working class. Finally, there was partial evidence that the number of alternative child-care arrangements during the first year accounted for the links between early maternal employment and subsequent child outcomes. Conclusions:, These results are congruent with extant research that posits a risk of early employment on socioemotional development, but show that this risk is partially attributable to child-care instability. [source]

Americans' Views of Health Care Costs, Access, and Quality

For more than two decades, polls have shown that Americans are dissatisfied with their current health care system. However, the public's views on how to change the current system are more conflicted than often suggested by individual poll results. At the same time, Americans are both dissatisfied with the current health care system and relatively satisfied with their own health care arrangements. As a result of the conflict between these views and the public's distrust of government, there often is a wide gap between the public's support for a set of principles concerning what needs to be done about the overall problems facing the nation's health care system and their support for specific policies designed to achieve those goals. [source]

Improving the Quality of Workers' Compensation Health Care Delivery: The Washington State Occupational Health Services Project

Thomas M. Wickizer
Researchers and health policy analysts in Washington State set out to determine the extent to which administrative process changes and delivery system interventions within workers' compensation affect quality and health outcomes for injured workers. This research included a pilot project to study the effects of providing occupationally focused health care through managed care arrangements on health outcomes, worker and employer satisfaction, and medical and disability costs. Based on the results, a new initiative was developed to incorporate several key delivery system components. The Washington State experience in developing a quality improvement initiative may have relevance for health care clinicians, administrators, policymakers, and researchers engaged in similar pursuits within the general medical care arena. [source]

Role of general practitioners in primary maternity care in South Australia and Victoria

Background:, Recent policy debates about the challenges facing maternity services in Australia provide an opportunity to reflect on current care practices. Aims:, To identify the provision of primary maternity care models in two Australian states: South Australia (SA) and Victoria. Methods:, All public and private hospitals with maternity facilities in SA and Victoria were mailed a survey requesting information about the organisation and provision of maternity care. Results:, All hospitals in SA (35) and 99% (75/76) in Victoria completed the survey. Among public hospitals, approximately 50% (14/30 in SA and 29/56 in Victoria) reported primary care arrangements where all antenatal care is provided by medical practitioners working in the community. The vast majority of hospitals offering this type of care were located outside metropolitan areas. Twenty per cent of public hospitals in SA (6/30) and 36% in Victoria (20/59) reported offering primary midwifery models, such as team, caseload and/or birth centre care. In SA, hospitals offering these models were located in both metropolitan and regional areas. In Victoria, 60% of hospitals offering women primary midwifery care were large hospitals with more than 1000 births per annum. Conclusions:, This study shows that community-based medical practitioners, general practitioners in particular, are major providers of maternity care despite the emergence of primary midwifery models of care. With 25% of the population living outside metropolitan areas in both states, providing access to choice and continuity of care for women living in regional and rural areas will be a challenge for maternity reform. [source]

Sharing obstetric care: barriers to integrated systems of care

Objectives: To map the provision of shared obstetric care in Victoria, and investigate the views of care providers about the ways in which current practice could be improved. Method: All Victorian public hospitals with <300 births per annum and a purposive sample of hospitals with <300 births per annum were mailed a questionnaire seeking information about current practice. Interviews with key informants (n = 32) were conducted at four case study sites. Results: The response rate to the hospital survey was 98% (42/43). Fourteen different models of shared care were identified. Two,thirds of hospitals with <300 births per annum (16/28) had three or more different models of shared care. Six hospitals (15%) had written guidelines for all models of shared care offered; 13 (32%) had written guidelines covering some models. Practice varied considerably in relation to: exclusion criteria, recommended schedule of visits and use of patient,held records. There was little consensus about the content of visits and responsibility fa covering particular aspects of care. Few hospitals (6/42) had written information for women about shared care. Care providers expressed divergent views regarding the question of where ultimate responsibility lies for individual patient care and for the overall management of shared care. Conclusions: Current funding arrangements provide strong incentives to expand enrolment in shared obstetric care. Expansion of shared care has occurred without the development of formal, consultative and agreed arrangements between providers, or adequate provision for monitoring, evaluation and review. The variety, complexity and fluidity of models of shared care and lack of agreed procedures contribute to difficulties experienced by both providers and women participating in shared care. Implications: Detailed evidence,based agreed guidelines developed in consultation with hospital and community providers, and provision of improved information to women about what to expect in shared care arrangements are urgently required. [source]

Attention Deficit Hyperactivity Disorder: New Ways of Working in Primary Care

Gill Salmon
Children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and prescribed pharmacotherapy require ongoing regular follow-up for many years. Recent literature outlining the role of primary care in the ongoing medication monitoring of children and young people with ADHD is reviewed. We propose that a General Practitioner with a Specialist Interest (GPwSI) model could be developed in relation to ADHD to ensure that shared care arrangements between CAMHS and primary care for children with ADHD are in place. Clinical materials to support GPs in this new role are described. [source]

Children of Mothers Admitted to Psychiatric Hospital: Care Arrangements and Mothers' Perceptions

Judi Cunningham
This paper describes the care arrangements made for children when their mothers are admitted to psychiatric hospital. It also describes at admission, and at 3 months follow-up, the views and opinions of mothers and carers with regard to the admission, its impact on the family, and the service received. It was found that children are predominantly cared for within their family when their mother is admitted to hospital, and that mothers and carers are concerned about the impact of the admission and its associated problems. [source]

Does Amount of Time Spent in Child Care Predict Socioemotional Adjustment During the Transition to Kindergarten?

Early Child Care Research Network, Human Development, National Institute of Child Health
To examine relations between time in nonmaternal care through the first 4.5 years of life and children's socioemotional adjustment, data on social competence and problem behavior were examined when children participating in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care were 4.5 years of age and when in kindergarten. The more time children spent in any of a variety of nonmaternal care arrangements across the first 4.5 years of life, the more externalizing problems and conflict with adults they manifested at 54 months of age and in kindergarten, as reported by mothers, caregivers, and teachers. These effects remained, for the most part, even when quality, type, and instability of child care were controlled, and when maternal sensitivity and other family background factors were taken into account. The magnitude of quantity of care effects were modest and smaller than those of maternal sensitivity and indicators of family socioeconomic status, though typically greater than those of other features of child care, maternal depression, and infant temperament. There was no apparent threshold for quantity effects. More time in care not only predicted problem behavior measured on a continuous scale in a dose-response pattern but also predicted at-risk (though not clinical) levels of problem behavior, as well as assertiveness, disobedience, and aggression. [source]