Good Helping Relationships in Child Welfare: Co-authored Stories of Success (FULL REPORT)

This project involved multiple, in-depth interviews with six worker-client dyads from child welfare. The dyads were selected on the basis of workers and clients agreeing that they had worked through some degree of negative interpersonal process toward the achievement of a good working relationship. For each dyad, two individual interviews with the worker and the client were followed by a joint interview. These interviews produced stories that described from workers\u27 and clients\u27 perspectives how the relationship developed over time, how difficulties were dealt with, and what impact the relationship had on the participants. Although these stories were written by the researchers, they were co-authored by workers and clients in the sense that the participants reviewed drafts of their stories, made suggestions for revisions, and agreed that the final product fairly represented their experience. Across story analyses yielded common themes with regard to worker and client contributions to the development of a good relationship, the qualities of a good relationship, and central issues and turning points in relationship development and client change. The results paint a picture of a good working relationship that is deeply human, integrates personal and professional elements, and takes time and effort to develop. Findings also provide insights about how the challenges of developing good relationships in child welfare, and in any helping endeavour, can be dealt with productively

Good Helping Relationships in Child Welfare: Co-authored Stories of Success (SUMMARY REPORT)

This project involved multiple, in-depth interviews with six worker-client dyads from child welfare. The dyads were selected on the basis of workers and clients agreeing that they had worked through some degree of negative interpersonal process toward the achievement of a good working relationship. For each dyad, two individual interviews with the worker and the client were followed by a joint interview. These interviews produced stories that described from workers\u27 and clients\u27 perspectives how the relationship developed over time, how difficulties were dealt with, and what impact the relationship had on the participants. Although these stories were written by the researchers, they were co-authored by workers and clients in the sense that the participants reviewed drafts of their stories, made suggestions for revisions, and agreed that the final product fairly represented their experience. Across story analyses yielded common themes with regard to worker and client contributions to the development of a good relationship, the qualities of a good relationship, and central issues and turning points in relationship development and client change. The results paint a picture of a good working relationship that is deeply human, integrates personal and professional elements, and takes time and effort to develop. Findings also provide insights about how the challenges of developing good relationships in child welfare, and in any helping endeavour, can be dealt with productively

“To Thine Own Self Be True”: A Narrative Analysis of Social Group Disengagement and Associated Identity Implications

The purpose of this qualitative study was to explore the experiences of individuals who had voluntarily disengaged from social groups that had once been central to their self-understandings. Theoretical underpinnings of the study proceeded from the distinction made by social psychologists between personal identity, self-definitions derived from an understanding of one’s self as unique, and social identity, self-definitions derived from an understanding and identification of one’s self as a member of social groups. The overarching aims were to: 1) determine if a disengagement process exists, and if so, to discover its defining characteristics and phenomenological aspects; 2) describe the shifts in personal and social identity that accompany a disengagement process; and 3) consider the implciations for direct social work practice. Two in-depth audio-recorded interviews were conducted with sixteen participants (9 females, 6 males, and 1 transgendered individual) who disengaged from a total of9 different types of social groups (e.g., occupational groups, religious groups, territorial socio-economic groups, sexual orientation groups, gender groups, and extremist groups). Interview transcripts were examined using narrative analysis with particular attention paid to the revelatory and constructive relationship between the disengagement stories and the identity of the participants. The findings of this study suggest that social groups disengagement is a definable social process, one that can be mapped using a three phase, nine stage model. Disengagement is the product of mounting feelings of incongruence between one’s personal and social identity, with the individual, in the end, deciding to privilege personal identity over social identity. The results of this study speak to the indomitable nature of the self to develop and the painful and destructive ramifications that occur when living with high levels of personal and social identity incongruence. An argument is made that social work, with its person-in-environment focus, is a profession uniquely suited to helping individuals who are disengaging from social groups. Guidelines for direct social work practice are presented

Siege and Response: Families’ Everyday Lives and Experiences with Children’s Residential Mental Health Services (FULL REPORT)

Purpose Our purpose in interviewing parents with a child placed in residential mental health treatment was threefold: (1) to understand the functioning of children requiring residential mental health treatment before, during, and after treatment; (2) to characterize parents’ perceptions of their families’ involvement with residential treatment; and, (3) to address the popular notion that children requiring residential treatment come from highly dysfunctional and potentially harmful families by describing prevalent family functioning patterns. Methodology|This report is based on information obtained by interviewing 29 primary caregivers who had a child placed in residential care at one of two Ontario children’s mental health agencies. Parents were visited in their homes by an interviewer to engage in one-on-one dialogue to explore dimensions of their everyday lives and reflect on their service experiences. Interviews consisted of a series of open ended questions and were approximately 1 ½ to 2 hours in length. Because of the labour intensive nature of qualitative investigations, there are limitations to the number of cases that can practically be included in a study; however, what is lost in generalizability is compensated for by a richer sense of the struggles facing these families. Parents’ Perceptions of Residential Services Parents were generally pleased with their child’s placement in a residential treatment center. Parents feel respected, valued, and understood by service providers. They experience staff as competent, compassionate, and helpful. Residential services offered respite for families and containment for focal children. Many parents reported gains made for themselves and their children. Yet only 17% of parents felt that sufficient gains had been made to warrant the discharge of their child from the center. Parents tended not to blame the residential center for the lack of progress. The also seemed unable to articulate what the residential center could have done differently. Yet these parents, extremely hopeful when they first had their child placed in residence, had to come to terms with the realization that service outcomes had not matched their hopes. These stories highlight both the complexity and the tenacious nature of these children’s mental health difficulties. They also provide a challenge to service providers. What do we do when good is not good enough? Changes in Child Functioning Before, During and After Residential CareThese stories provide dramatic testimony that most of the older cohort children in this study leaving residential care had very serious ongoing problems in daily living. Problems which in many cases rivaled or exceeded the challenges faced prior to entering residential care. About one-third of these children had left home and many had unstable living arrangements or were “on the streets”. With the exception of living on their own and involvement in delinquent activities, and notwithstanding moderately more evidence of “successful” or partially “successful” adaptations, the after care daily living portraits of younger cohort residential care graduates were not notably more encouraging. About half of these younger children did not return to their original homes 6 after residential care. Serious areas of concern shared by both groups of children include continuing major adaptation problems at school and continued high levels of pressure on the parents and siblings of many of these children. Parent and Family FunctioningCaring for the focal child permeates every facet of daily life for these families including work, health, and relationships. Parents experience prolonged elevated levels of daily stress trying to juggle work schedules, appointments with professionals, household activities, and the needs of family members with caring for the focal child. Family climate is markedly tense and frequently involves conflict, particularly with the focal child. Relationships among other family members suffer as well, with parents reporting increased marital strain and little time to devote to siblings of the focal child. Caring for the focal child is taxing on parents’ own physical and mental health. Most families (70%) reported experiencing substantial relief, at least for a short period of time, from tensions within the home when the focal child entered residential care. Child Functioning Over Three Selected Developmental PeriodsOne of the interpretative challenges inherent in these stories is understanding the connection between the behaviour of these children, which is strikingly similar, and evidence suggestive of these children having a variety of problems, life histories and family environments. It can be argued that these children arrive at a similar point from many different trajectories. Who are the children represented in this sample? How are we to understand their difficulties? When it comes to understanding the behaviour of the focal children, both its presentation and its genesis, these stories raise as many questions as they answer. These stories challenge the notion of a single or root cause of extreme unmanageable behaviour. Instead they offer a complex and unsettling portrayal of these children, their familial and social environments, life histories, their strengths and challenges. These stories caution against the use of blanket or catch-all interpretations to help us understand the problematic behaviour of these children. ConclusionDespite the positive view of residential treatment held by parents long after treatment ends, the data suggest relatively poor outcome patterns for children leaving residential care. Serious areas of concern shared by both groups of children include continuing major adaptation problems at school and continued high levels of pressure on the parents and siblings of many of these children. The clearest area of benefit from these residential placements, at least in the short run, is for family members other than the focal child. This is an important consideration, given the incredible pressures families manage when the focal child is at home, and the extreme disruptions in family life described in these stories. An obvious question emanating from these stories is what can be expected for these children - in school, employment and relationships - over the years ahead. There is almost no support in our study for helping strategies predicated on “curing” or changing the focal child through short-term or medium-term interventions so that he or she can prosper in everyday life. Variations in living arrangements, enhancing school and employment opportunities, and continuing support to these children and their families with the challenges of daily living merit serious attention

Siege and Response: Families’ Everyday Lives and Experiences with Children’s Residential Mental Health Services (SUMMARY REPORT)

Our purpose in interviewing families who had a child placed in residential children’s mental health treatment was to provide insight into the lives and service experiences of these families as they struggle to care for their child and find appropriate services. As we endeavored to code, categorize, and make sense of the information shared with us by families several other more pointed purposes emerged as integral to our efforts. More specifically we became interested in understanding the functioning of children requiring residential mental health treatment before, during, and after treatment with the aim to comment on general patterns of change for these children across these three time periods. Secondly, we also aimed to characterize parents’ perceptions of their families’ involvement with residential treatment. In particular we address parents’ understanding of the services, their relationships with service providers, and parents’ perceptions of their children’s experiences. And thirdly, in order to provide a family context for children’s difficulties and the ensuing service involvement, we also discuss family functioning highlighting key family patterns under the domains of work, daily life, and relationships. The inclusion of prevalent family functioning patterns also helps us to address the popular notion that children requiring residential treatment come from highly dysfunctional and potentially 3 harmful families. Each of these three purposes are addressed in turn in an effort to provide a more complete picture of the families involved in residential treatment and their service experiences. We conclude with some implications for service delivery and thoughts to pursue in future investigations

Good Helping Relationships in Child Welfare: Co-authored Stories of Success (FULL REPORT)

This project involved multiple, in-depth interviews with six worker-client dyads from child welfare. The dyads were selected on the basis of workers and clients agreeing that they had worked through some degree of negative interpersonal process toward the achievement of a good working relationship. For each dyad, two individual interviews with the worker and the client were followed by a joint interview. These interviews produced stories that described from workers\u27 and clients\u27 perspectives how the relationship developed over time, how difficulties were dealt with, and what impact the relationship had on the participants. Although these stories were written by the researchers, they were co-authored by workers and clients in the sense that the participants reviewed drafts of their stories, made suggestions for revisions, and agreed that the final product fairly represented their experience. Across story analyses yielded common themes with regard to worker and client contributions to the development of a good relationship, the qualities of a good relationship, and central issues and turning points in relationship development and client change. The results paint a picture of a good working relationship that is deeply human, integrates personal and professional elements, and takes time and effort to develop. Findings also provide insights about how the challenges of developing good relationships in child welfare, and in any helping endeavour, can be dealt with productively

Good Helping Relationships in Child Welfare: Co-authored Stories of Success (SUMMARY REPORT)

This project involved multiple, in-depth interviews with six worker-client dyads from child welfare. The dyads were selected on the basis of workers and clients agreeing that they had worked through some degree of negative interpersonal process toward the achievement of a good working relationship. For each dyad, two individual interviews with the worker and the client were followed by a joint interview. These interviews produced stories that described from workers\u27 and clients\u27 perspectives how the relationship developed over time, how difficulties were dealt with, and what impact the relationship had on the participants. Although these stories were written by the researchers, they were co-authored by workers and clients in the sense that the participants reviewed drafts of their stories, made suggestions for revisions, and agreed that the final product fairly represented their experience. Across story analyses yielded common themes with regard to worker and client contributions to the development of a good relationship, the qualities of a good relationship, and central issues and turning points in relationship development and client change. The results paint a picture of a good working relationship that is deeply human, integrates personal and professional elements, and takes time and effort to develop. Findings also provide insights about how the challenges of developing good relationships in child welfare, and in any helping endeavour, can be dealt with productively

Siege and Response: Families’ Everyday Lives and Experiences with Children’s Residential Mental Health Services (SUMMARY REPORT)

Our purpose in interviewing families who had a child placed in residential children’s mental health treatment was to provide insight into the lives and service experiences of these families as they struggle to care for their child and find appropriate services. As we endeavored to code, categorize, and make sense of the information shared with us by families several other more pointed purposes emerged as integral to our efforts. More specifically we became interested in understanding the functioning of children requiring residential mental health treatment before, during, and after treatment with the aim to comment on general patterns of change for these children across these three time periods. Secondly, we also aimed to characterize parents’ perceptions of their families’ involvement with residential treatment. In particular we address parents’ understanding of the services, their relationships with service providers, and parents’ perceptions of their children’s experiences. And thirdly, in order to provide a family context for children’s difficulties and the ensuing service involvement, we also discuss family functioning highlighting key family patterns under the domains of work, daily life, and relationships. The inclusion of prevalent family functioning patterns also helps us to address the popular notion that children requiring residential treatment come from highly dysfunctional and potentially 3 harmful families. Each of these three purposes are addressed in turn in an effort to provide a more complete picture of the families involved in residential treatment and their service experiences. We conclude with some implications for service delivery and thoughts to pursue in future investigations

Siege and Response: Families’ Everyday Lives and Experiences with Children’s Residential Mental Health Services (FULL REPORT)

Purpose Our purpose in interviewing parents with a child placed in residential mental health treatment was threefold: (1) to understand the functioning of children requiring residential mental health treatment before, during, and after treatment; (2) to characterize parents’ perceptions of their families’ involvement with residential treatment; and, (3) to address the popular notion that children requiring residential treatment come from highly dysfunctional and potentially harmful families by describing prevalent family functioning patterns. Methodology|This report is based on information obtained by interviewing 29 primary caregivers who had a child placed in residential care at one of two Ontario children’s mental health agencies. Parents were visited in their homes by an interviewer to engage in one-on-one dialogue to explore dimensions of their everyday lives and reflect on their service experiences. Interviews consisted of a series of open ended questions and were approximately 1 ½ to 2 hours in length. Because of the labour intensive nature of qualitative investigations, there are limitations to the number of cases that can practically be included in a study; however, what is lost in generalizability is compensated for by a richer sense of the struggles facing these families. Parents’ Perceptions of Residential Services Parents were generally pleased with their child’s placement in a residential treatment center. Parents feel respected, valued, and understood by service providers. They experience staff as competent, compassionate, and helpful. Residential services offered respite for families and containment for focal children. Many parents reported gains made for themselves and their children. Yet only 17% of parents felt that sufficient gains had been made to warrant the discharge of their child from the center. Parents tended not to blame the residential center for the lack of progress. The also seemed unable to articulate what the residential center could have done differently. Yet these parents, extremely hopeful when they first had their child placed in residence, had to come to terms with the realization that service outcomes had not matched their hopes. These stories highlight both the complexity and the tenacious nature of these children’s mental health difficulties. They also provide a challenge to service providers. What do we do when good is not good enough? Changes in Child Functioning Before, During and After Residential CareThese stories provide dramatic testimony that most of the older cohort children in this study leaving residential care had very serious ongoing problems in daily living. Problems which in many cases rivaled or exceeded the challenges faced prior to entering residential care. About one-third of these children had left home and many had unstable living arrangements or were “on the streets”. With the exception of living on their own and involvement in delinquent activities, and notwithstanding moderately more evidence of “successful” or partially “successful” adaptations, the after care daily living portraits of younger cohort residential care graduates were not notably more encouraging. About half of these younger children did not return to their original homes 6 after residential care. Serious areas of concern shared by both groups of children include continuing major adaptation problems at school and continued high levels of pressure on the parents and siblings of many of these children. Parent and Family FunctioningCaring for the focal child permeates every facet of daily life for these families including work, health, and relationships. Parents experience prolonged elevated levels of daily stress trying to juggle work schedules, appointments with professionals, household activities, and the needs of family members with caring for the focal child. Family climate is markedly tense and frequently involves conflict, particularly with the focal child. Relationships among other family members suffer as well, with parents reporting increased marital strain and little time to devote to siblings of the focal child. Caring for the focal child is taxing on parents’ own physical and mental health. Most families (70%) reported experiencing substantial relief, at least for a short period of time, from tensions within the home when the focal child entered residential care. Child Functioning Over Three Selected Developmental PeriodsOne of the interpretative challenges inherent in these stories is understanding the connection between the behaviour of these children, which is strikingly similar, and evidence suggestive of these children having a variety of problems, life histories and family environments. It can be argued that these children arrive at a similar point from many different trajectories. Who are the children represented in this sample? How are we to understand their difficulties? When it comes to understanding the behaviour of the focal children, both its presentation and its genesis, these stories raise as many questions as they answer. These stories challenge the notion of a single or root cause of extreme unmanageable behaviour. Instead they offer a complex and unsettling portrayal of these children, their familial and social environments, life histories, their strengths and challenges. These stories caution against the use of blanket or catch-all interpretations to help us understand the problematic behaviour of these children. ConclusionDespite the positive view of residential treatment held by parents long after treatment ends, the data suggest relatively poor outcome patterns for children leaving residential care. Serious areas of concern shared by both groups of children include continuing major adaptation problems at school and continued high levels of pressure on the parents and siblings of many of these children. The clearest area of benefit from these residential placements, at least in the short run, is for family members other than the focal child. This is an important consideration, given the incredible pressures families manage when the focal child is at home, and the extreme disruptions in family life described in these stories. An obvious question emanating from these stories is what can be expected for these children - in school, employment and relationships - over the years ahead. There is almost no support in our study for helping strategies predicated on “curing” or changing the focal child through short-term or medium-term interventions so that he or she can prosper in everyday life. Variations in living arrangements, enhancing school and employment opportunities, and continuing support to these children and their families with the challenges of daily living merit serious attention

Accelerated in vivo proliferation of memory phenotype CD4+ T-cells in human HIV-1 infection irrespective of viral chemokine co-receptor tropism.

CD4(+) T-cell loss is the hallmark of HIV-1 infection. CD4 counts fall more rapidly in advanced disease when CCR5-tropic viral strains tend to be replaced by X4-tropic viruses. We hypothesized: (i) that the early dominance of CCR5-tropic viruses results from faster turnover rates of CCR5(+) cells, and (ii) that X4-tropic strains exert greater pathogenicity by preferentially increasing turnover rates within the CXCR4(+) compartment. To test these hypotheses we measured in vivo turnover rates of CD4(+) T-cell subpopulations sorted by chemokine receptor expression, using in vivo deuterium-glucose labeling. Deuterium enrichment was modeled to derive in vivo proliferation (p) and disappearance (d*) rates which were related to viral tropism data. 13 healthy controls and 13 treatment-naive HIV-1-infected subjects (CD4 143-569 cells/ul) participated. CCR5-expression defined a CD4(+) subpopulation of predominantly CD45R0(+) memory cells with accelerated in vivo proliferation (p = 2.50 vs 1.60%/d, CCR5(+) vs CCR5(-); healthy controls; P<0.01). Conversely, CXCR4 expression defined CD4(+) T-cells (predominantly CD45RA(+) naive cells) with low turnover rates. The dominant effect of HIV infection was accelerated turnover of CCR5(+)CD45R0(+)CD4(+) memory T-cells (p = 5.16 vs 2.50%/d, HIV vs controls; P<0.05), naïve cells being relatively unaffected. Similar patterns were observed whether the dominant circulating HIV-1 strain was R5-tropic (n = 9) or X4-tropic (n = 4). Although numbers were small, X4-tropic viruses did not appear to specifically drive turnover of CXCR4-expressing cells (p = 0.54 vs 0.72 vs 0.44%/d in control, R5-tropic, and X4-tropic groups respectively). Our data are most consistent with models in which CD4(+) T-cell loss is primarily driven by non-specific immune activation