Doctoral student, Brandeis University- Heller School for Social Policy and Management
Testing innovative interventions: Improving care by adopting relationship-care concept
Nursing homes and mental hospitals were the only facilities to accommodate people with disabilities offering low care quality and no interaction with the community. The passage of Americans with Disability Act (ADA) in 1990 acknowledged the right of people with disability to fully live and integrate with the community. Since then, many states tried to end institutionalization by offering community-integrated residential facilities. After almost 30 years of ADA passage, many people with disability still feel alienated and socially isolated. This study uses the theory of relational coordination and its seven dimensions to identify obstacles to mainstreaming people with disability; specifically, victims of acquired brain injury. Direct care staff (DCS), working in community integrated residential facilities in Massachusetts, were asked to evaluate relations and coordination level with each other, higher management, the residents, their family and the community. The relational coordination (RC) standardized survey evaluates relation and coordination index through seven dimensions; communications' frequency, timeliness, accuracy, problem solving coordination, shared goals, shared knowledge and mutual respect. The study introduces the RC theory and survey for staff in two different models of residential facilities for victims of acquired brain injury: Waiver model and group residential model. Baseline data identified the weakest ties with residents' family and the community. Over the period of six months, local change team, volunteered staff members, conducted meetings to analyze the baseline results and discuss reasons behind the low RC scores with family and the community. They identified lack of awareness on brain injury as medical condition and its variation from mental illness as the main reason behind low interaction with the communities. Other factors included cultural and racial differences as the direct care staff (DCS) are mostly recent African immigrants to the united states. Also, many families didn't apprehend the extent of DCS involvement in residents' care and often treated them as low-level aid. Based on these qualitative inputs, the change team began series of intervention to strengthen these ties by holding town hall meetings to raise awareness, pamphlets to local stores and started a tradition of family cookout in residential homes. This is a pilot study measuring innovative interventions to improve quality of care through improving relations.
Abstract: Authors: Davidson ; M. Article URL: http://alh.oxfordjournals.org/cgi/content/short/28/2/433?rss=1 Citation: Vol 28 No. 2 (2016) pp 433 453 Publication Date: 2016-04-26T08:49:49-07:00 Journal: American Literary History
Pub.: 26 Apr '16, Pinned: 01 Oct '17
Abstract: Massachusetts is one of a very limited number of states exclusively employing participant-direction to deliver autism waiver services to children. A crucial element of this waiver program is the work conducted by the state's Department of Developmental Services (DDS) staff and state-approved providers with waiver families to facilitate the implementation of the participant-direction model. Our study investigates the effect of the collaboration between state providers and family caregivers on family well-being.We conducted a survey of 74 families who have been utilising waiver services for at least 6 months. Participants were asked to rate the coordination with providers as well as to report on parenting stress and impact of waiver services on family functioning. Data from in-home child and family assessments conducted by the state were also abstracted from program records.After controlling for a host of variables hypothesised to affect the outcomes of interest, we found that the family's view of how well they coordinated with formal providers is significantly associated all of the outcomes. Families who reported greater coordination with state providers experienced lower parenting stress and reported a more positive impact on family functioning. Child externalising behavioural problems and caregiver's health rating also contributed to parenting stress and family functioning.Our findings highlight the importance of establishing a collaborative partnership with waiver families in promoting family well-being. These results suggest that training and/or resources that foster team building and communication can positively impact family functioning among families with young children with autism.
Pub.: 21 Oct '14, Pinned: 01 Oct '17
Abstract: To identify agency policies and workplace characteristics that are associated with intent to leave the job among home health workers employed by certified agencies.Data are from the 2007 National Home and Hospice Care Survey/National Home Health Aide Survey, a nationally representative, linked data set of home health and hospice agencies and their workers. Logistic regression with survey weights was conducted to identify agency and workplace factors associated with intent to leave the job, controlling for worker, agency, and labor market characteristics.Job satisfaction, consistent patient assignment, and provision of health insurance were associated with lower intent to leave the job. By contrast, being assigned insufficient work hours and on-the-job injuries were associated with greater intent to leave the job after controlling for fixed worker, agency, and labor market characteristics. African American workers and workers with a higher household income also expressed greater intent to leave the job.This is the first analysis to use a weighted, nationally representative sample of home health workers linked with agency-level data. The findings suggest that intention to leave the job may be reduced through policies that prevent injuries, improve consistency of client assignment, improve experiences among African American workers, and offer sufficient hours to workers who want them.
Pub.: 24 Apr '16, Pinned: 01 Oct '17
Abstract: In the half century since enactment of the 1965 Great Society programs, accomplishments were gradually made to improve access to and quality of long-term services and supports (LTSS), including: mitigation of financial and care abuses in nursing facilities (NFs); substantial rebalancing of LTSS towards consumer-preferred home-and-community-based services (HCBS); increasing flexible consumer-centered HCBS including payment to family caregivers; and more assisted-living and housing options for seniors with heavy care needs. A unified planning and advocacy agenda across age and disability type and greater consumer transparency fueled progress. Nonetheless, LTSS is a broken system; persistent problems interfere with substantial and necessary change. These include; over-emphasis on safety for LTSS consumers; inattention to physical environments in all settings; regulatory and professional rigidity; and poor communication and information. Our recommendations are aimed at builders and designers, LTSS professionals, regulators, and educators/trainers; the last may be crucial in forging new consensus and over-coming entrenched beliefs. Policy recommendations include relatively narrow steps-for example, requiring single occupancy in all NFs and assisted living settings financed with public dollars-to broad reworking of the prerequisites for livable age-friendly (and dementia-friendly) communities and for a capable, flexible LTSS workforce.
Pub.: 04 Jun '15, Pinned: 01 Oct '17