'It's the system working for the system': carers' experiences of learning disability services in Ireland

Irish social policy to family carers of adults with an intellectual disability: A critical analysis

This paper explores contemporary Irish social policy for family caregivers with specific focus on the dynamic between the individual, the family and the state in terms of the social contract for care provision for people with intellectual disability. Drawing from Bacchi's analytical framework (Bacchi, 2009), the Irish National Carers' Strategy is interrogated specifically with regards to how it frames and assumes the social contract for family care provision for adults with an intellectual disability. We suggest that Irish social policy constructs family caregiving as the assumed natural and neutral point of departure for providing care within society, and this constructed identify is subsequently reinforced through the provisions contained with the policies themselves that seek to support such caregivers. A fundamental reconsideration of the social contract for such care provision and support with society would appear warranted.

"I don't care anymore if she wants to cry through the whole conversation, because it needs to be addressed": Adult siblings' experiences of the dynamics of future care planning for brothers and sisters with a developmental disability

BACKGROUND

In families with a member with a developmental disability (DD), future care planning is limited (Brennan et al., Journal of Applied Research in Intellectual Disabilities, 31, 2018, 226; Bowey and McGlaughlin, British Journal of Social Work, 31, 2007, 39; Davys et al., Journal of Intellectual Disability, 14, 2010, 167; Davys et al., British Journal of Learning Disabilities, 43, 2014, 219; Davys et al., Journal of Applied Research in Intellectual Disabilities, 29, 2016, 220). However, most siblings without disabilities (SWD) expect to be involved in the future care of their brother or sister with DD (Benderix and Sivberg, International Paediatric Nursing, 22, 2007, 410; Gomez de la Cuesta and Cos, We exist too: Valuing the contributions of siblings, UK, National Autistic Society, 2012; Heller and Arnold, Journal of Policy and Practice in Intellectual Disabilities, 7, 2010, 16).

MATERIALS AND METHODS

Based on qualitative interviews with 25 SWD in Ireland, this article explores how SWD experience future planning.

RESULTS AND DISCUSSION

The findings indicate that SWD experience care planning as an ongoing, fluid and emotionally charged process. Parental fears, about future care landscapes they do not control and about passing on intergenerational care responsibilities, emerge as key factors inhibiting planning.

CONCLUSION

Attention to the highly emotive nature of care concerns, and to the tentative pace of planning that is comfortable for families, will help professionals provide optimum planning support.

Irish persons with intellectual disability moving from family care to residential accommodation in a period of austerity

BACKGROUND

Ireland has a growing population of adult persons living with family carers, thereby increasing the demand for residential places. Simultaneously, government policy aimed to reprovision residents living in congregated settings but at a time when funding was curtailed due to the economic crisis. This study examines the movements of people into and among three types of residential options between 2009 and 2014.

METHOD

A cohort of 20,163 persons recorded on the National Intellectual Disability Database in 2009 was identified and tracked to the 2014 database.

RESULTS

An estimated 200 persons per annum (@1.6% of those living with families) moved from family care although the number of places available nationally fell by 9%. Moreover, transfers of existing residents into vacated places tended to exceed those from families.

CONCLUSIONS

More people will have to continue living with their families and for longer if funding for new places remains curtailed.

Barriers to non-residential respite care for adults with moderate to complex needs: A UK perspective

Respite aims to alleviate the stress and burden of caring for someone with an intellectual disability and/or autism. Respite can take place in a number of different ways, but most commonly occurs in a residential setting. Based on survey and interview data with carers (CAs), service users and stakeholders (STs) in a northern city in England, this article explores some of the perceived or actual barriers to availing 'non-residential' respite. A number of barriers to non-residential respite are identified. Residential respite appears to be the default conceptualization of 'respite' for carers, service users and stakeholders. Persuading carers, service users and stakeholders to give up the familiarity and safety of residential respite in favour of a non-residential alternative will be challenging unless those involved are more informed. Limitations and directions for future research are suggested.

Meeting the communication support needs of children and young people with intellectual disabilities in the Bolivian Andes

Services available for people with disabilities in Bolivia tend to be fragmented and costly. Children and adults with intellectual disabilities are more likely to have a related communication disability and are thus both literally and metaphorically excluded from having a voice. The following research aimed to explore the experiences of accessing services by people with communication disabilities in Bolivia through semi-structured interviews and one focus group carried out with family members, professionals, service providers, educators and policymakers. It aimed to establish the nature of current services in Bolivia where knowledge, information and resources are scarce. Findings indicated the need to consider an alternative to a medical model approach through a focus on empowering other stakeholders to participate more fully in meeting communication support needs. Conclusions plot ideas for future service delivery and emphasize the central power of sharing practical and expert knowledge.

Out of School and Into Distress: Families of Young Adults with Intellectual and Developmental Disabilities in Transition

BACKGROUND

The transition period out of the educational system can be a source of stress for parents of young adults with intellectual and developmental disabilities, as families lose the support and respite offered by schools.

MATERIALS AND METHODS

Using a before and after design nested within a 24-month follow-up study of parents seeking adult developmental services for their children, parents' perception of distress was measured using the Brief Family Distress Scale (Journal of Child and Family Studies, 20, 2011, 521) and their perception of helpfulness of formal supports was assessed using the Family Support Scale (Journal of Individual, Family, and Community Wellness, 1, 1984, 45).

RESULTS

Parents reported significantly higher levels of distress after their child transitioned out of school. Employed parents and parents of a child with an autism spectrum disorder are at increased risk for distress.

CONCLUSIONS

Families fare worse once their adult children are no longer in school, although this is not associated with a reduction in the perception of the helpfulness of formal supports.

Good practice in social care: the views of people with severe and complex needs and those who support them

This paper reports findings drawn from a study of good practice in English social care for adults with disability and older people with severe and complex needs. People with severe and complex needs are a relatively small proportion of adult social care service users, but they are growing in numbers and have resource-intensive needs. The study involved qualitative research with adults with disability and older people with severe and complex needs, family carers and members of specialist organisations (n = 67), focusing on the features of social care services they considered to be good practice. Data were collected between August 2010 and June 2011. The approach to data collection was flexible, to accommodate participants' communication needs and preferences, including face-to-face and telephone interviews, Talking Mats(©) sessions and a focus group. Data were managed using Framework and analysed thematically. Features of good practice were considered at three levels: (i) everyday support; (ii) service organisation; and (iii) commissioning. Findings relating to the first two of these are presented here. Participants emphasised the importance of person-centred ways of working at all levels. Personalisation, as currently implemented in English social care, aims to shift power from professionals to service users through the allocation of personal budgets. This approach focuses very much on the role of the individual in directing his/her own support arrangements. However, participants in this study also stressed the importance of ongoing professional support, for example, from a specialist key worker or case manager to co-ordinate diverse services and ensure good practice at an organisational level. The paper argues that, despite the recent move to shift power from professionals to service users, people with the most complex needs still value support from professionals and appropriate organisational support. Without these, they risk being excluded from the benefits that personalisation, properly supported, could yield.

Negotiating the social service systems: a vital yet frequently invisible occupation

Independent living and community participation are long-term rehabilitation goals. Disability scholars and activists have highlighted that access to social services is vital to the ability of people with disabilities to live and participate in the community as full and equal citizens. The field of occupational therapy has paid relatively little attention to how people with disabilities negotiate these systems. This article examines the vital but often invisible occupation of negotiating the social service systems using data from a 16-month ethnographic study of women with disabilities who were transitioning to independent living. Findings revealed that material, social, and attitudinal barriers in the service delivery systems restricted the women's access to resources and forced them to be highly resourceful to find, secure, and manage the social services they needed to maintain independent living. Theoretical and clinical implications for occupational therapy are discussed.

A fragile bond: adoptive parents' experiences of caring for children with a diagnosis of reactive attachment disorder

AIMS AND OBJECTIVES

To understand how adoptive parents caring for children with a diagnosis of reactive attachment disorder (RAD) make sense of their life-worlds by establishing the meanings that underlie and structure their experiences of their everyday lives.

BACKGROUND

Reactive attachment disorder is a serious psychosocial disorder of childhood that causes short- and long-term relationship, health and social consequences for children. It is more likely to be observed in children being cared for by foster carers, kinship carers or adoptive parents. Exploration of adoption from parents' perspectives is not well documented, and no previous work has been undertaken to understand the challenges of caring for children with a diagnosis of reactive attachment disorder.

DESIGN

The study was guided by Husserl's phenomenology, which aims to uncover the underlying essential meanings intrinsic to a phenomenon. Three concepts are central to this approach: essences, intuiting and eidetic reduction.

METHODS

Semi-structured interviews were conducted with eight adoptive parents. Data were analysed using an adaptation of Colaizzi's method.

RESULTS

Four essential elements fundamental to participants' lived experiences of caring for a child with a diagnosis of RAD were uncovered: being profoundly unprepared, being insecure, being assailed by unexpected emotions and being committed.

CONCLUSIONS

The parent-child relationship is a fragile bond developed at an unexpectedly high personal cost; it is a committed relationship but vulnerable to continual destabilisation. The involvement in the preparation of adoptive parents of child and adolescent mental health (CAMH) staff with expertise in the impact of early neglect or separation on children should be considered.

RELEVANCE TO CLINICAL PRACTICE

The development of systems to prepare, screen and identify potential challenges and problems prior to adoption might help adoptive parents. Access to a CAMH professional in the pre and postadoption phases might assist potential adoptive parents in making informed decisions around the choice of a child for adoption.

Family voices: life for family carers of people with intellectual disabilities in Ireland

BACKGROUND

Families in Ireland remain the main providers of support for people with Intellectual disabilities, and the aim of this study was to map their life experiences whilst involving their family members as co-researchers.

MATERIALS AND METHOD

This qualitative, participatory study involved 10 focus groups attended by 70 parents and siblings of people with intellectual disabilities. Data were analysed using thematic analysis.

RESULTS

Caring for a family member with intellectual disabilities was found to be a dynamic and adaptive process. The well-being of the family and the challenges they face throughout their lives was the central theme identified. This was affected by: the availability of appropriate supports for families and having to advocate for them, communication and relationships with services and professionals, the availability of information and attitudes towards disability and governmental support.

CONCLUSIONS

Strategies are suggested as to how services can better support family carers in Ireland in their role. These include families being provided with flexible and timely support for families at critical times; being offered services, support, entitlements and information without having to fight for them; knowing that their family member with intellectual disabilities is well cared for, listened to and provided with opportunities to develop and be part of the community; and carers being shown respect, listened to and involved in decisions.

Can we move beyond burden and burnout to support the health and wellness of family caregivers to persons with dementia? Evidence from British Columbia, Canada

After more than a decade of concerted effort by policy-makers in Canada and elsewhere to encourage older adults to age at home, there is recognition that the ageing-in-place movement has had unintended negative consequences for family members who care for seniors. This paper outlines findings of a qualitative descriptive study to investigate the health and wellness and support needs of family caregivers to persons with dementia in the Canadian policy environment. Focus groups were conducted in 2010 with 23 caregivers and the health professionals who support them in three communities in the Southern Interior of British Columbia. Thematic analysis guided by the constant comparison technique revealed two overarching themes: (1) forgotten: abandoned to care alone and indefinitely captures the perceived consequences of caregivers' failed efforts to receive recognition and adequate services to support their care-giving and (2) unrealistic expectations for caregiver self-care relates to the burden of expectations for caregivers to look after themselves. Although understanding about the concepts of caregiver burden and burnout is now quite developed, the broader sociopolitical context giving rise to these negative consequences for caregivers to individuals with dementia has not improved. If anything, the Canadian homecare policy environment has placed caregivers in more desperate circumstances. A fundamental re-orientation towards caregivers and caregiver supports is necessary, beginning with viewing caregivers as a critical health human resource in a system that depends on their contributions in order to function. This re-orientation can create a space for providing caregivers with preventive supports, rather than resorting to costly patient care for caregivers who have reached the point of burnout and care recipients who have been institutionalised.

Why do families relinquish care? An investigation of the factors that lead to relinquishment into out-of-home respite care

BACKGROUND

Families/carers relinquishing the care of family members with a disability into the care of out-of-home respite facilities is an under-researched area in the disability field. With this in mind, the aim of this study was to explore the factors that lead to families relinquishing care, the potential early indicators that families are considering relinquishment; the factors that may prevent relinquishment and the outcomes for families/carers after relinquishment occurs.

METHOD

Thirty-two client files (of individuals for whom families have relinquished their care in a defined 12-month period) were reviewed for information around their relinquishment into out-of-home respite care facilities for an extended stay. Staff members involved with these families (a total of 17) were also interviewed to provide more information.

RESULTS

A thematic analysis of the results found that the factors that led to relinquishment could be categorised into: (1) characteristics inherent to the individual with intellectual disability; (2) characteristics inherent to the family/carer; and (3) characteristics associated with the support context that the carer/family is currently experiencing. It was also found that families'/carers' experienced positive outcomes after relinquishment had occurred; however, feelings of guilt and mourning were initially felt.

CONCLUSIONS

Extra supports (e.g. increased respite care, planning for movement of the family member into out-of-home permanent accommodation and case management) and positive interventions such as parent training were highlighted as potential strategies to achieve more lasting benefits from short-stay out-of-home respite care.

Working with carers in the next decade: the challenges

This paper outlines two challenges to community nurses as they work with unpaid carers. These reflect a changing culture in the way that health care will be delivered in the coming decade. The first of these challenges is a shift towards focusing on outcomes for both service users and adult carers. Outcomes evidence the impact a service has on a person's life. The second is the increasing focus on the concept of carers as partners in care.

Current perceptions of respite care: experiences of family and informal carers of people with a learning disability

Access to regular, high-quality respite care has a beneficial impact on a carer's ability to fulfil their caring role, but provision varies widely. The current study aims to report family and informal carers' perceptions of respite care services offered to them by their local authority. A mixed method, triangulated design, yielded both quantitative and qualitative data. Members of a parent/carer federation were sent a questionnaire which included a section on 'respite care'; 151 of 647 responded. Two focus groups were held with 15 carers who had previously completed the questionnaire. The majority of carers reported that their respite needs were not being met. Unmet needs were hampered by the lack of information regarding criteria for access to respite. Discrepancies were evident between professionals and carers on a shared definition of respite care. Carers were unsure of exactly which activities constituted respite care and for whom the service was being provided.