Ideologies of care in community residential services: what do caregivers believe?

Use of prevention and prevention plus weight management guidelines for youth with developmental disabilities living in group homes

INTRODUCTION

Prevention and Prevention Plus strategies for weight management were implemented for youth with developmental disabilities living in community group homes at a Midwestern educational/residential center.

METHODS

Caregiver staff were provided with weight management education, a communication tool for youth weight indices, weight and physical activity goals, dietary orders, and monthly follow-up communication. This 4-month study examined changes in weight indices, nutrition, physical activity, and staff perceptions of youth status using t tests, χ(2) tests, and Wilcoxon signed-rank tests.

RESULTS

A significant decrease in mean body mass index percentile was found (t(39) = 2.93, p < .01, 95% confidence interval 1.29 to 7.04) that was primarily from change in the healthy weight category. More than 80% of the 40 youth achieved their weight goal. A significant improvement in daily fruit consumption ( p = .001) and vegetable consumption ( p < .001) was reported.

DISCUSSION

These prevention strategies are useful to promote staff understanding of dietary goals for weight management in youth with developmental disabilities living in group homes and should be incorporated into practice by health care providers. Additional efforts are needed to increase physical activity during the winter months.

The values and qualities of being a good helper: a qualitative study of adult foster home caregivers for persons with serious mental illness

BACKGROUND

Canadian foster homes for adults with serious mental illness are operated by non-professional caregivers, usually women, whose mandate is to support residents and reintegrate them into the community. While mental health professionals recognize that adult foster homes are an important service for this population, there is little understanding of how caregivers impact on the lives of their residents.

AIMS AND OBJECTIVES

This article draws on the findings of a larger study which examined both caregiver and resident perspectives on the helping relationship in adult foster homes. Caregiver perspectives on the values and qualities required to help people living in foster homes are reported.

DESIGN AND METHODS

With no pre-set theoretical framework, this qualitative study employed an inductive approach within a naturalistic paradigm. Semi-structured interviews were conducted with 20 caregivers. Data analysis was an ongoing, 2-year process, involving the identification of categories and themes through several distinct stages.

SETTING

The study included Montreal adult foster homes (n=242) for persons with serious mental illness, supervised by two university-affiliated psychiatric hospitals.

PARTICIPANTS

Twenty caregivers, selected according to years of experience and number of residents in the home, were diverse in terms of age, cultural background, family composition, education and occupational background.

RESULTS

Caregivers possess a clearly articulated value system, and 21 specific qualities which reflect the attributes of both professional and informal helpers. These values and qualities provide caregivers with a "professional" or "vocational" orientation.

CONCLUSIONS

A deeply held system of values and qualities is critically important to caregiver effectiveness and job satisfaction. Findings suggest that caregivers are highly motivated, and should be recognized as full participants in the mental health system at both policy and practice levels.

Community mental health care: documenting the role of the nurse

In Australia, the process of deinstitutionalisation has resulted in the closure or downsizing of many large stand-alone psychiatric hospitals. The aim of modern community mental health care is to provide treatment and rehabilitation for people, who have a mental illness, in their local community. This aim is supported by the Australian National Mental Health Strategy that outlines the importance of health professionals, carers, and consumers working together to obtain the best therapeutic outcomes. This study was undertaken to obtain information regarding the current role of the community mental health nurse (CMHN). All community mental health nurses working in the Adult Program at the Directorate of Mental Health Services, Fremantle Hospital and Health Service in Western Australia participated in the study. The study was completed in November 2000. The results showed that the CMHNs' role focused on six main areas. These areas included the day-to-day management of clients, working with carers and their families; crisis work for both existing andfirst time contacts; as well as liaison and advocacy work. Thefinding of this study demonstrate CMHN's work most often with acutely ill and psychotic patients and theirfamilies. Therefore, CMHN's play a pivotal role in promoting and sustaining the philosophy of community mental health care. In addition, the liaison work within the community completed by CMHN's is vital to address the mental health needs of the community and to reduce the stigma associated with mental illness. The documentedfindings of this study provide challengesfor thefurther expansion of the CMHN's role and the development of best practice initiatives in community mental health care.