Clara C. Pratt

Measuring Program Outcomes: Using Retrospective Pretest Methodology

This study used longitudinal data from 307 mothers with firstborn infants participating in a home-visitation, child-abuse prevention program. A self-report measure of specific constructs the program hoped to affect showed that the retrospective pretest methodology produced a more legitimate assessment of program outcomes than did the traditional pretest-posttest methodology. Results showed that when response shift bias was present, traditional pretest-posttest comparisons resulted in an underestimation of program effects that could easily be avoided by the retrospective pretest methodology. With demands for documenting program outcomes increasing, retrospective pretest designs are shown to be a simple, convenient, and expeditious method for assessing program effects in responsive interventions. The limits of retrospective pretests, and methods for strengthening their use, are discussed.

The predictive impact of domestic violence on three types of child maltreatment.

OBJECTIVE This exploratory study investigated the co-occurrence of domestic violence and three types of child maltreatment: physical child abuse, psychological child abuse, and child neglect. METHOD A sample of 2544 at-risk mothers with first-born children participated in a home-visiting child abuse prevention program. A longitudinal design using multiple data collection methods investigated the effect of domestic violence during the first 6 months of child rearing on confirmed physical child abuse, psychological child abuse, and child neglect up to the childs first 5 years. RESULTS Logistic regressions revealed significant relationships between domestic violence and physical child abuse, psychological child abuse, and child neglect. These effects were significant beyond the significant effects of known risks of maltreatment, as measured by the Kempe Family Stress Inventory (KFSI). Domestic violence occurred in 59 (38%) of the 155 cases of confirmed maltreatment. Domestic violence preceded child maltreatment in 46 (78%) of the 59 cases of co-occurrence, as indicated by independent home observations and child protective service records. CONCLUSIONS The findings indicate that domestic violence during the first 6 months of child rearing is significantly related to all three types of child maltreatment up to the childs fifth year. Domestic violence and risks factors measured on the KFSI continue to contribute to all three types of maltreatment up to the childs fifth year. Prevention programs would be wise to provide services to at-risk families until the child is at least 5 years old. Addressing concurrent problems during treatment may enhance intervention.

Informal Caregiving to Aging Family Members: A Critical Review

Since the early 1980s, there has been an explosion of literature on caregiving to aging family members. This work appears in a variety of outlets, but mostly in gerontological journals, and somewhat peripherally in journals specifically focused on families. Within the family caregiving literature, there is great ambiguity around three significant questions: (a) What is caregiving? (b) What are the negative and positive outcomes of caregiving for caregivers? and (c) What is the relation between family or informal caregiving and paid or formal caregiving? Confusion in these three areas makes it difficult to compare findings across studies and to draw reliable implications for practice. Thus, we examine the literature on caregiving to aging family members with particular attention to the family aspect of caregiving, addressing these three central questions. Throughout this review, we note assumptions and empirical gaps in the literature, as well as the implications of this literature for researchers and for practitioners who work with family members, particularly the caregivers. WHAT IS CAREGIVING? Most commonly, family caregiving has been conceptualized as occurring when one or more family members give aid or assistance to other family members beyond that required as part of normal everyday life. Generally, family caregiving begins when aging family members require assistance due to debilitating chronic conditions or diseases, such as severe arthritis, significant sensory loss, Parkinsons Disease, Alzheimers Disease, or when they are otherwise frail. A review of the family caregiving literature, however, reveals that a clear and precise definition, which is essential for researchers and for professionals who work with family caregivers, is 1 missing (Barer & Johnson, 1990; Cantor, 1991; MaloneBeach & Zarit, 1991). Caregiving Versus Aid Caregiving is not always easily distinguished from aid given as a part of the normal exchange in family relationships. Some of the difficulty in defining family caregiving rests in the history and nature of the connection between the caregiver and the care receiver. Even when care receivers have similar levels of dependence, the help provided by family caregivers differs by gender and by generation (Dwyer & Seccombe, 1991). For example, using data from the 1982 National Long-Term Care Survey and the associated National Survey of Informal Caregivers, Dwyer and Seccombe (1991) found that caregiving husbands reported giving more care than wives. The authors suggested that caregivers report activities that are not ordinary for them or that are not part of their normal responsibilities. As wives and/or mothers, women perform many tasks, such as laundry, meal preparation, house cleaning, and so on, that are included in measures of instrumental activities of daily living (IADLs; e.g., laundry, meal preparation). Because IADLs are consistent with everyday household work (Sankar, 1993), wives may not consider such tasks to be caregiving activities, but husbands, who are less often involved in household work, and who take on these tasks primarily because their wives are unable to do them, see dusting and vacuuming as caregiving. In the same way, daughters may distinguish the tasks they do in their own households from those they do in the homes of their mothers and fathers. Cleaning house is typically a responsibility of wives in their own homes, but having to do so in another house is caregiving. Similarly, in the National Health Interview Survey, men aged 75 and above were less likely than women to report needing assistance with IADLs, but equally likely to report needing assistance with activities of daily living (ADLs), such as bathing and walking (Pratt, Sasser-Coen, & Acock, 1993). Perhaps older men did not see in themselves a need for IADL assistance because someone had always done these tasks for them, but help with grooming, bathing, and dressing was recognized as aid. …

Predictors of burnout in professional and paraprofessional nurses working in hospitals and nursing homes

Burnout is a phenomenon in which the cumulative effects of a stressful work environment gradually overwhelm the defenses of staff members, forcing them to psychologically withdraw. To understand the experience of professional and paraprofessional nurses suffering from burnout requires a close examination of the environments in which they function. This study examined interpersonal, intrapersonal and situational factors expected to contribute to the six dimensions of burnout among nursing staff who worked in acute care and long-term care health facilities. The sample included 312 professional and paraprofessional nurses. The following research question was explored using a series of stepwise multiple regression analyses: of the following variables interpersonal (professional exposure to patients with poor prognosis for survival, work relationships, informal support), intrapersonal (coping strategies, fear of death, comfort working with patients with poor prognosis for survival) and situational (personal and work demographics), which are the significant predictors of the six dimensions of burnout in professional and paraprofessional nurses? Findings revealed that work relationships and tension-releasing and instrumental problem-focused coping were the most powerful predictors of burnout. Based upon this, it was concluded that nursing burnout is both an organizational and a personal problem. Recommendations for practice are presented.

Burden, Coping and Health Status

This study investigates caregiver health, burden and coping strategies of family caregivers to institutionalized and community-dwelling Alzheimers disease patients. Patient residence was significantly related to caregiver health status, sources of burden and the efficacy of various strategies for reducing burden. Implications for intervention with family caregivers are discussed.

Adaptation of the 36-Month Ages and Stages Questionnaire in Taiwan: Results From a Preliminary Study

Identification of children with developmental disabilities is the first critical step in providing early intervention services. Currently, only 20% of Taiwanese children who could potentially benefit from early intervention have been identified. One possible reason for this low identification rate is the lack of a culturally appropriate, developmental screening instrument for Taiwanese children. A multi-pronged pilot study was conducted to explore the reliability and validity of scores using a Chinese translation of the 36-month version of the Ages and Stages Questionnaire (ASQ) with a sample of Taiwanese children. Results indicated that the translated Chinese version of the 36-month ASQ demonstrates initial cultural appropriateness, and reliability and validity of scores when used with a sample of 3-year-old Taiwanese children. The potential viability of the 36-month ASQ as a developmental screening instrument to identify Taiwanese children in need of early intervention services and the need for further validation research are discussed.

Burnout: Differences Between Professional and Paraprofessional Nursing Staff in Acute Care and Long-Term Care Health Facilities

In burnout the cumulative effects of a stressful work environment gradually overwhelm the defenses of staff members, forcing them to withdraw psychologically. Understanding the experience of professional and paraprofessional nurses who suffer from burnout requires a close examination of the environments in which they function. We examined differences in nursing burnout by occupational levels (professional versus paraprofessional nurses), type of facility (acute care hospitals versus long-term care facilities), and professional exposure to patients with poor prognosis for survival (high, moderate, low). The sample included 312 nurses who worked in three acute care and seven long-term care health facilities. Multivariate analysis of variance was used to analyze the data. We found paraprofessional nurses significantly higher on two dimensions of burnout (emotional exhaustion and depersonalization) than professional nurses. In addition, paraprofessional nurses perceived less support in their work environments than did professional nurses. Furthermore, nurses working in long-term care facilities experienced emotional exhaustion more frequently than did nurses working in acute care facilities. We present recommendations for practice and future research.

The Child in Grief: Implications for Teaching.

Based on a thorough review of the literature, this paper presents information on child bereavement. It takes a particular focus on the implications for teaching young children about death and loss. Child educators are in a position to provide a safe environment in which children can explore the concepts of death and dying. For the bereaved child the classroom can be a place where support is offered and expression of feelings toward the loss is allowed. In addition, teachers can help educate parents about various behaviors children manifest in expressing their grief. Given such information, parents may be better able to cope and respond to their childs needs.

AGING AND FAMILY CAREGIVING IN THE FUTURE: IMPLICATIONS FOR EDUCATION AND POLICY

The major demographic and social shifts that are now occurring in American society will significantly affect the roles of family members as caregivers to the elderly in the coming years. These shifts are identified and suggestions for education and policy are discussed.

Service workers' responses to abuse of the elderly

The social service providers and physicians who encounter elder abuse have several potential avenues of intervention open to them in helping the elderly. Practice and training issues are discussed that are relevant for improving interventions and referrals in cases of family abuse of the elderly.