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Child Welfare

Tending the Caregivers

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Mothers who work as healthcare professionals – physicians, physician assistants and nurse practitioners – can significantly reduce their stress levels and burnout by participating in close supportive groups at work, according to a new study by researchers at Arizona State University and the Mayo Clinic. The shared experiences in these support groups provide a wealth of nurturance for the women.

The study, “Fostering resilience among mothers under stress: ‘Authentic Connections Groups’ for medical professionals,” is published in the current issue of Women’s Health Issues.

Groups in the intervention provided “comfort, solace and advice as needed, building what some called a ‘secret sisterhood’ of shared experiences with genuineness and reciprocity in the relationship,” said Suniya Luthar, a Foundation professor of psychology at ASU and the lead author of the study. “These factors help build resilience for professional mothers who are under great daily stress, with substantial dual demands at work and at home.”

Senior co-author and collaborator on the project was Dr. Cynthia Stonnington, associate professor and chair of psychiatry at the Mayo Clinic College of Medicine, Arizona. Other authors of the paper are Alexandria Curlee, an ASU graduate student; Susannah Tye, Department of Psychiatry and Psychology at the Mayo Clinic, Minnesota; and Judith Engelman, a psychiatrist in private practice.

“Women medical professionals who are mothers often face the dual role of being the primary caregiver both for their patients and their children,” said Stonnington. “This puts them at higher risk for burnout than their male counterparts. Our study investigated how this supportive program might help mitigate stresses and promote their day-to-day health and well-being.”

The Authentic Connections Groups (ACG) intervention involved weekly sessions at work over a three-month period. The researchers randomly assigned 40 women at Mayo to one of two groups: either the 12 weekly one-hour sessions of the ACG’s or 12 weekly hours of protected time to be used as desired. The study was supported by a Seed fund from Arizona State University to Luthar, and the Mayo Clinic contributed release time to participate.

The study had several positive results.

It showed that those who participated in the ACGs had significantly greater reductions in depression and other global symptoms of stress than those given free time (the control group). Secondly, relative gains were still more pronounced three months after the program ended. Follow-up assessments showed significant between-group differences not only on depression and stress, but also on almost all other central variables, including parenting stress, self-compassion, feeling loved and physical affection. Participants in the ACGs also showed more reductions than control moms in cortisol levels (a biochemical indicator of stress) at both post intervention and three months follow up.

In explaining why this program worked, Luthar said that, in essence, the ACGs actively and continually fostered the development of close, mutually supportive relationships, and the resulting shared experiences and bonding helped to lower participants’ stress levels.

“Resilience research clearly shows the critical protective power of reliable close relationships,” Luthar said. “In this program, our focus was on developing and strengthening what we called ‘go-to’ committees for each woman. As topics were shared in the weekly group sessions over time, the moms each also shared them with their respective go-to’s. By the end of three months, each woman had developed great closeness not only with other moms in their work setting but also with at least two or three other women in their personal lives.”

A critical factor in enabling this effort was the institutional commitment to wellness. Stonnington reported that the ACG program was implemented as part of an initiative begun in 2015 at the Mayo Clinic in Arizona to address burnout and turnover among female physicians.

“Another major reason for the success of this program is that the groups were implemented in the women’s everyday settings, during their regular work-days,” said Luthar. “That the Mayo administration gave them the one hour per week free time to participate was a critical consideration, given how very packed these women’s schedules can be.”

The U.S. Surgeon General recently stated that efforts to promote the well being of medical professionals must become a major priority among health care organizations. This study demonstrates that facilitated colleague support groups can provide a viable, low-cost preventive way to mitigate burnout among women medical professionals who are also mothers.

More broadly, the authors note that the ACG program has the potential to be widely used in workplace wellness programs, given the high cost of worker stress and depression in contemporary America. Since completion of the Mayo project, Luthar and colleagues have successfully completed groups with military mothers, and are now offering it to women in the STEM (science, technology, engineering, and mathematics) disciplines, with both new projects implemented at ASU.

“It is our hope that over time, the ACG program will come to benefit women, mothers, and other adults in salient caregiving roles, as they routinely give so much of themselves to others while experiencing high everyday stress,” Luthar said. “It just makes common sense. Those who serve as first-responders, and who offer so much tending for many others, must themselves be tended – with this happening on a reliable and ongoing basis.”

Social Work Helper is a news, information, resources, and entertainment website related to social good, social work, and social justice. To submit news and press releases email [email protected]

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Child Welfare

Head Start May Protect Against Foster Care Placement

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Participating in Head Start may help prevent young children from being placed in foster care, finds a national study led by a Michigan State University researcher.

Kids up to age 5 in the federal government’s preschool program were 93 percent less likely to end up in foster care than kids in the child welfare system who had no type of early care and education, said Sacha Klein, MSU assistant professor of social work.

Klein and colleagues examined multiple forms of early care and education – from daycare with a family member to more structured programs – and found Head Start was the only one to guard against foster care placement.

“The findings seem to add to what we already know about the benefits of Head Start,” Klein said. “This new evidence suggests Head Start not only helps kids develop and allows parents to go to work, but it may also help at-risk kids from ending up in the foster care system.”

Klein and colleagues studied the national survey data of nearly 2,000 families in which a child had entered the child welfare system for suspicion of abuse or neglect. Those children were either pulled from the home or were being overseen by a caseworker.

Klein said Head Start may protect against foster care because of its focus on the entire family. Services go beyond providing preschool education to include supporting parental goals such as housing stability, continued education and financial security.

There are more than 400,000 children in foster care in the United States, about a third of them under the age of 5, according to the most recent report from the U.S. Department of Health and Human Services. All children in foster care automatically qualify for free Head Start services, regardless of income level.

Klein said the findings suggest policymakers should consider making all children in the child welfare system, including those living at home, automatically eligible for Head Start. That could help prevent more kids from ending up in foster care.

While foster care can be a vital resource for protecting children from abusive and neglectful parents, it is rarely a panacea for young kids, the study notes.

“Indeed, young children who are placed in foster care often have compromised socio-emotional, language and cognitive development and poor early academic and health outcomes,” the authors write. “Trauma and deprivation experienced before removal may largely drive these developmental deficits, but foster care often fails to alleviate them and sometimes can worsen them.”

Klein’s co-authors are Lauren Fries of MSU and Mary Emmons of Children’s Institute Inc. in Los Angeles.

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Child Welfare

To Counter Child Abuse, Administrators and Case Workers Need Support to Implement Evidence-Based Improvements

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In 2015, more than 425,000 children were placed in foster care due to incidents of abuse and neglect. But many unsubstantiated cases under investigation divert time and resources from handling cases that warrant close monitoring and attention. According to recent statistics, more than two million reports of child abuse and neglect were accepted for investigation in 2015 – with more than 700,000 of them eventually substantiated as cases of child abuse or neglect.

Imperfect Responses to Harmful Abuse and Neglect

Caseworkers often report that negotiating the multiple demands of their jobs puts them under constant stress. The sheer volume of Child Protective Services reports and investigations, the number of youth in foster care that need to be looked after, and the piles of paperwork that must be filled out to track decision-making – all of these burdens are overwhelming under the best of circumstances.

Faced with such workloads, agencies and caseworkers are ill-equipped to deliver services based on evidence of what works for youth and parents in the foster care system. The current standard of practice, however, leads agencies and caseworkers to engage in practices not supported by research-based evidence. Poorly conceived and delivered services cause considerable harm by failing to limit the incidence and after-effects of abuse and neglect.

Victims of child abuse and neglect are nine times more likely to become involved in crime and 25% more likely to experience teen pregnancy. Such victims also face increased risks of smoking, early-age drinking, suicidal ideation, inter-personal violence, and sexual risk-taking. The sad results become obvious in later years. Two-thirds of adults under treatment for drug abuse report that they were maltreated as children. And similar reports of childhood abuse come from 14% of men in prison along with 36% of incarcerated women. Four-fifths of 21-year-olds who were abused as children show evidence of at least one mental health disorder. And saddest of all, about 30% of child abuse victims will later abuse their own kids.

What Could be Done?

Several steps can be taken to improve responses to child abuse and neglect:

  • Improved, ongoing training and job support for caseworkers and supervisors could ensure that they know the characteristics of the populations they serve and are aware of effective anti-abuse practices and know how to deliver them or help clients find others in the community who can provide optimal help. Front-line workers also need training to monitor client progress and detect when a case warrants more intensive intervention.
  • Enhanced preventive efforts could save lives and money. Research shows that the total cost of new U.S. cases of fatal and nonfatal child maltreatment was approximately $124 billion in 2008. The estimated cost per victim of nonfatal child maltreatment was $210,012 in 2010, including the costs for health care, productivity losses, child welfare services, criminal justice procedures, and special education. In fatal cases, the figure rises to an astonishing $1,272, 900 per death.
  • Resources should be reallocated to areas of greatest need. In addition to redistributing available funding to hire more staff to manage high caseloads, innovative and effective programs and services must be delivered to prevent child maltreatment and fatalities. States should take advantage of funds offered by the federal government to expand evidence-based child welfare interventions that may have previously been underfunded.

Lessons from Philadelphia

A promising model comes from the state of Pennsylvania, which has participated in a federally funded project that allows child welfare agencies to use Title IV-E funds for evidence-based reforms. Philadelphia’s child welfare system has been at the forefront of adopting three evidence-based treatments for children and families that the city was previously unable to implement due to lack of funding. Waiver funds have made it possible to enhance preparation for child welfare caseworkers, develop databases to track outcomes for children and families, and train staff to identify and implement further improvements.

With flexible authority over spending, two child welfare agencies in Philadelphia decided to implement the Positive Parenting Program, an evidence-based approach to preventing child abuse. Although some reallocated resources have been used to train staff, additional funding is needed to discover barriers to effective program implementation and to implement additional steps known to be cost-effective – such as holding weekly consultations and boosting training for current and replacement leaders and caseworkers involved in the new program.

Research could pinpoint which approaches do best at giving various parents and youth access to the positive parenting program. And as parents and their offspring complete the program, further research would ideally track results in areas such as safety, reductions in abuse incidents, and improved parent-child relationships.

Next Steps

The Title IV-E Waiver Demonstration Project was a provision in the U.S. Child and Family Services Improvement and Innovation Act, which Congress reauthorized for five years in 2011. Now that the act is again up for reauthorization, Congress has the ability to implement changes to the way child welfare federal funds are allocated. Advocates for children have an opportunity to contact representatives and senators in Congress to propose that this program should expand to give more states the chance to reallocate funds and improve child safety.

Much remains to be learned about what it takes to carry out evidence-based interventions in the child welfare system, which provides vital help to many endangered children, youth, and families, disproportionately minorities. The federal Waiver Project provides a unique opportunity to observe what happens when system leaders, community partners, and providers mobilize to prevent childhood trauma. Lessons learned will help provide ongoing guidance to federal and state administrators and welfare leaders as they look for the most effective, empirically proven ways to protect children and families under their supervision.

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Child Welfare

Connected Commonwealth: Programs for Kentucky Youth Aging Out

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Photo Credit: Foster Youth In Action

In May 2016, Anna Shobe-Wallace, program manager for Louisville Metro Community Services said, “Each year, more than 500 young people between the ages of 18-21 age out of Kentucky’s foster care system.” Many youth ‘aging out’ are disconnected from larger society and face barriers to success such as: low socioeconomic status, low educational achievement, unplanned pregnancy, racial segregation, and mental and physical challenges.

A recent study assessed the plight of disconnected youth who are teenagers and young adults between the ages of 16 and 24, and these youths are neither employed, enrolled in or attending school. The study focused on disconnected youth in the following categories: by state, county, congressional district, gender, and by race and ethnicity. Currently, there is approximately 5,527,000 disconnected youth in the United States or 13.8% of young adults.

According to data from the study:

  • Kentucky ranks 36th in youth disconnection rates with 15.2% of youth in this group for a total of 81,850.
  • Cincinnati, OH–KY–IN ranks 44th in youth disconnection among the most densely inhabited areas. The percentage of disconnected youth in this area is 12.8% or 38,312 total. The racial breakdown for this group is 20.6% Black and 11.8% White.
  • Louisville/Jefferson County, KY–IN ranks 56th in youth disconnection. The percentage of disconnected youth in this area is 14.0% with a total of 21,750 disconnected youth. The racial breakdown for this group is 18.5% Black and 13.3% White. This Kentucky county has the lowest percentage of disconnected youth.
  • Kentucky counties with the largest percentage of disconnected youth are as follows: Martin County, Kentucky ranks 2,020th with 47.8% disconnected youth; Union County, Kentucky ranks 2012 with 43.7% disconnected youth; Bracken County, Kentucky ranks 1,998th with 41.4% disconnected youth; Lee County, Kentucky ranks 1,994th with 40.9% disconnected youth; McCreary County, Kentucky ranks 1,992nd with 40.4% disconnected youth; Morgan County, Kentucky ranks 1,985th with 38.7% disconnected youth; and Wolfe County, Kentucky ranks 1,972nd with 37.5% disconnected youth

Researchers from this study concluded that larger urban communities had increased numbers of disconnected youth due to the following indicators: a historical pattern of disconnection, decreased neighborhood well-being rates, low SES, increased unemployment, a lack of academic achievement, and racism.

These alarming statistics clearly indicated systemic issues that impact disconnected youth. Experts from this study proposed that, “Disconnection is not a spontaneously occurring phenomenon; it is an outcome year in the making.” With this thought in mind, the study recommended these steps moving forward:

  • An estimated $26.8 billion dollars was involved with supporting the nation’s 5.5 million disconnected youth— comprising Supplemental Security Income payments, Medicaid, public assistance, incarceration, in 2013. Proposing more beneficial ways to invest in this population would be advantageous to society as a whole.
  • Designing preventive measures to address disconnection by sustaining at-risk parents and investing in quality preschool programs. It is usually more cost effective and compassionate to implement prevention strategies than crisis responses.
  • Re-joining youth and young adults who are secluded from higher education and the job market is more expensive than pre-emptive methods that address disconnection at the outset. However, these young people need another opportunity—considering many came from challenging backgrounds.
  • At the community level, an evident positive correlation was seen between adult employment status and youth’s relationship to education and employment. The amount of education adults had greatly projected the likelihood of young people ages 16 to 24 years old to attend school.
  • Significant headway involves individuals and organizations cooperating to institute specific measurable attainable realistic timely (SMART) goals for decreasing youth disconnection.

Amy Swann, author of “Failure to Launch”, notes that for 2013, the study data indicates that the Louisville Metropolitan Area (which consists of bordering counties) has 14.0 percent of youth ages 16-24 disengaged from employment and education. The study’s emphasis on cities resulted in reporting by Louisville news outlets at the Courier-Journal and WFPL. Media exposure of the status of disconnected youth in Kentuckiana has led to remarkable new efforts that focus on this population.

In light of this compelling evidence: social workers, legislators, and other helping professionals in the state of Kentucky have amassed their efforts to cultivate community partnerships and programs to support disconnected youth on their journey into emerging adulthood.

According to their website, here is a description of each program, and how it addresses the needs of disconnected youth and youth ‘aging out’.

Family Scholar House plans to open its fifth Louisville campus at the Riverport Landings development in southwest Jefferson County. The project goal is to equip families and youth to excel in education and to obtain independence. The new facility is expected to be ready by 2017 and will accommodate low-income families, single-parent families, and young adults formerly in foster care.

Fostering Success is a summer employment program developed by Gov. Matt Bevin that began June 1, 2016. The program provides job training via the Kentucky Department for Community Based Services for youth ages 18 to 23 years old. The program will run for 10 weeks and culminate with meetings with college and career counselors to prepare participants for future education and employment goals. Approximately 100 youth will be employed full-time at a rate of $10.00 dollars per hour. Fostering Success is one of the seminal programs in the state to target youth aging out.

Project LIFE serves 60 kids across Kentucky, including 25 in Louisville and offers an empowering environment to prepare them for success. Youth are given a housing voucher, along with social supports to improve access to education, employment, and income management skills.

Coalition Supporting Young Adults (CYSA) is an initiative created to address the barriers faced by Louisville’s disconnected young people. The mission is to develop: a standard agenda that meets the needs of Louisville’s vulnerable youth and young adults; common measurement tools that define collective goals and strategies; mutually supportive activities that create new partnerships and execute thoughtful programs; effective communication that creates a viable structure; foundational support that stimulates growth, responsibility, and dependability.

Transition Age Youth Launching Realized Dreams (TAYLRD) is an effort to create a unique program for young people born out of the federal government’s proposal called “Now is the Time” Healthy Transitions Grant Program. The Department of Behavioral Health (DBH) in Kentucky requested and received funding and Seven Counties was chosen as a venue to open drop-in centers where young people can foster relationships and access support /services to achieve their future goals. Youth Peer Support Specialists (YPSS) and Youth Coordinators work together with clients to define what concerns are most important, and then appropriate services/supports are brought into the drop-in centers. Some of the supports/services offered include: case management, life skills development, employment services, academic support, legal support, and therapy.

True Up founded by foster care alum Frank Harshaw, is a nurturing group of foster care alumni who have overcome obstacles to employment, pursuing education, gaining independence and solidifying healthy relationships. They have chosen to pay it forward through mentorship. True Up empowers foster youth through academic and hands-on learning in the following areas: Mobility & Transportation, Career Mapping, Financial Management, Relationship Building Skills, and Educational Achievement.

These are just a few of the innovative programs and resources available in the state of Kentucky. As helping professionals and the broader community create data driven programs for disconnected youth and youth aging out, expected outcomes will be much more positive in the near future.

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