Family Support And Mental Health Care Quality In Nursing Homes Serving Residents With A Mental Health History

The prevalence of mental health disorders among the nursing home population is well recognized. However, providing adequate mental health services for nursing home residents who need them remains a challenging endeavor. The social support of family has long been recognized as a key resource for older adults with a mental health history and older adults residing in nursing homes. The purpose of this study is to examine the quality of mental health care provided for nursing home residents with a mental health history and to determine if family support influences the quality of their mental health care accounting for other facility resident and facility organizational characteristics. The study utilized a retrospective, cross-sectional design with 2003 national Online Survey Certification and Reporting (OSCAR) facility data merged with the resident-level Minimum Data Set (MDS) resulting in N=2,499 nursing homes. Guided by the convoy model of social support and socioemotional selectivity theory, descriptive statistics and exploratory factor analysis were used to create a profile of facility level data of nursing home residents with a mental health history, explore the role of family support, and determine if items within the OSCAR and MDS databases could respectively be used to measure mental health care quality and family support. Overall, it was found that families have a positive relationship with their relatives and are involved in their lives. Additionally, items within the OSCAR and MDS databases could be used to measure mental health care quality and family support. Finally, facility organizational characteristics explained more variation in the quality of mental health care than did facility resident, family support, or market characteristics. In sum, to enhance the quality of mental health care in nursing homes, partnering with families may be an important tool to meet resident needs

The Changing Nature of Accountability in Administrative Practice

This article looks at the subject of accountability in the administration of the human services. The history of accountability over the last four decades is chronicled and discussed. The point is made that during this period, funders have largely determined the nature of accountability. Because funders have been primarily concerned with funding, accountability has tended to be financial in nature. The authors argue that the focus on financial accountability had two major detrimental effects. First, programmatic accountability was reduced to secondary importance. Second, a wedge was driven between macro administrative practice and micro direct practice as social work managers and administrators became almost exclusively concerned with financial accountability to the detriment of programmatic accountability. The authors go on to suggest that the performance measurement movement has united programmatic and financial accountability and has reunited macro administrative practice and micro direct practice

Social Service Staffing in US Nursing Homes

Using data from the 2003 national Online Survey Certification and Reporting System, this study examines how the structure of social service staffing in nursing homes is affected by organizational and contextual factors. The results suggest that, although federal regulations impose minimal obligation, requiring only facilities with more than 120 beds to employ qualified social service providers, nearly 12 percent of these facilities failed to meet this staffing requirement in 2003. Results further suggest that the skill mix of social service providers in nursing homes is influenced by market competition, market demand, facility ownership, aggregate resident acuity, and the proportion of facility residents funded by Medicare

Facility Service Environments, Staffing, and Psychosocial Care in Nursing Homes

Using 2003 Online Survey Certification and Reporting (OSCAR) data for Medicare and Medicaid certified facilities (N=14, 184) and multinomial logistic regression this study investigated if (1) psychosocial care quality was better in facilities where State requirements for qualified social services staffing exceeded Federal minimum regulations and (2) facility service environments are associated with psychosocial care quality. For-profit status and higher percentage of Medicaid residents are associated with lower quality. Staffing, market demand, and market competition are associated with better quality. Psychosocial care quality is more associated with payer status and market forces and less with regulatory requirements

Multiple Recurrent De Novo CNVs, Including Duplications of the 7q11.23 Williams Syndrome Region, Are Strongly Associated with Autism

SummaryWe have undertaken a genome-wide analysis of rare copy-number variation (CNV) in 1124 autism spectrum disorder (ASD) families, each comprised of a single proband, unaffected parents, and, in most kindreds, an unaffected sibling. We find significant association of ASD with de novo duplications of 7q11.23, where the reciprocal deletion causes Williams-Beuren syndrome, characterized by a highly social personality. We identify rare recurrent de novo CNVs at five additional regions, including 16p13.2 (encompassing genes USP7 and C16orf72) and Cadherin 13, and implement a rigorous approach to evaluating the statistical significance of these observations. Overall, large de novo CNVs, particularly those encompassing multiple genes, confer substantial risks (OR = 5.6; CI = 2.6–12.0, p = 2.4 × 10-7). We estimate there are 130–234 ASD-related CNV regions in the human genome and present compelling evidence, based on cumulative data, for association of rare de novo events at 7q11.23, 15q11.2-13.1, 16p11.2, and Neurexin 1

From Government To Governance: Implications For Social Work Administration

The way in which our society governs itself has undergone a quiet revolution over the last two decades. Society is in the midst of a paradigm shift from what is known as a government paradigm to what is being called a governance paradigm. This article seeks to inform social work administrators about the importance of the shift. First, some background is provided on the dueling paradigms of the 1980s and 1990s, from which the governance paradigm emerged. Next, the major characteristics of the governance paradigm are identified and contrasted with the older, more established government paradigm. The implications of the governance paradigm for social work administration are then discussed. Finally, the article concludes with some thoughts about changes in the educational preparation of social work administrators required by the ascendance of the governance paradigm. © Taylor & Francis Group, LLC

Family Support In Nursing Homes Serving Residents With A Mental Health History

Using 2003 nursing home data from the Minimum Data Set (MDS) database, this study investigated the role of family support among nursing homes serving residents with a mental health history. Exploratory factor analysis was used to create and test a conceptual model of family support using indicators located within the MDS database. Families were found to be in regular contact with their relatives and supportive of their care. In nursing homes, daily contact, an ongoing relationship, involvement in assessment, and being responsible for the resident constitute the model family support. This study advances the understanding of family support in nursing homes and conveys information to guide practice through proposing ways to enhance family support and involvement in nursing homes. © Taylor & Francis Group, LLC