Bibliotek

The overall aim of the research presented here was to identify and explore aspects of the school environment that influence the participation of students with physical disabilities. The first study examined the reliability and validity of the School Setting Interview (SSI), which is a new assessment still under development. The results showed that the inter-rater reliability was good or very good and that the SSI was able to accurately identify those students who needed to have adjustments made for them. An examination of the content validity indicated that the items included were adequate for the assessment's intended purpose. In a continuation of this research, the SSI was used to identify adjustment needs for students with severe physical disabilities attending a specially adapted upper secondary school. The results showed that most unmet needs were connected to writing, examinations and reading. Overall, 39 % of the needs for adjustments that had been identified were unmet by the school. It is suggested that one describes adjustments at three different levels in relation to the students who have access to them: a general one, a group one, and an individual one.

The SSI was then used to investigate environmental barriers in regular schools. Simultaneously, an investigation was made of how gender, diagnosis, academic grade, the availability of an assistant and the level of locomotion were related to how well the environment suited the students. It was demonstrated that the way in which activities are organised and carried out in school is the area in need of most improvement to promote the participation of students with physical disabilities. The findings also suggest that the older students with disabilities and those who do not have access to an assistant should be prioritised when adjustments are being made.

The next stage of the study was to investigate how temporal structures in the school setting influenced the schoolwork of students with disabilities. It was found that the teaching style determined the pace and defined the temporal pattern in the classroom. Four teaching styles were identified with different influences on the students' opportunities to participate. An educational dilemma was discovered regarding how best to provide equal learning opportunities for students with physical disabilities; this is discussed. Finally, research was conducted to increase the understanding of how the presence of an assistant in school influences the participation of students with physical disabilities. It was revealed that assistance was arranged to promote participation in learning, while the students themselves often prioritised social participation with peers. The pupils had limited influence over the assistance provided and little control over when and how support was given. In turn, these diverging priorities and the lack of influence sometimes precluded appropriate assistance being given to the students with disabilities, thereby affecting their overall opportunities to participate in class.

In summary, this thesis revealed that the organisation of activities, teaching styles and the provision of assistance were aspects of the social environment that especially influenced students' opportunities to participate. The ambiguity and complexity of facilitating participation also created dilemmas where the provision of support intended to facilitate participation might threaten another aspect of participation. On the basis of the results, a definition of participation is suggested that incorporates performance and the students' feeling of involvement and belonging, as well as the students' opportunities for decision-making.

Aim. To develop a brief, multi-dimensional instrument for assessing treatment outcome for people with drug and/or alcohol problems. The Maudsley Addiction Profile (MAP) is the first instrument to be developed in the United Kingdom for this purpose. Design. Field testing with quota-recruitment of problem drug users and problem alcohol users in treatment with researcher and clinician-administered test-retest interviews. Setting. Two community and two inpatient services at the Bethlem Royal and Maudsley Hospital, London. Participants. Subjects (160 drug users and 80 alcohol users) interviewed by eight interviewers (four researchers and four clinicians), each of whom interviewed 30 subjects on two occasions. Measures. Sixty items across substance use, health risk, physical/psychological health and personal/social functioning domains. Findings. Average completion time of the MAP was 12 minutes. The questionnaire was acceptable to a majority of subjects and performed well with both researcher and clinician interviewers. Internal reliability and feasible concurrent validity assessments of the scales and items were highly satisfactory. Test-retest reliability was good, average intraclass correlation coefficients across eight substances were 0.94 and 0.81 across health risk, health problems, relationship conflict, employment and crime measures. Conclusions. The MAP can serve as a core research instrument with additional outcome measures added as required. The collection of a set of reliable quantitative measures of problems among drug and alcohol users by research or treatment personnel for outcome evaluation purposes need not be time-consuming.

The purpose of this paper is to explore the meanings of outdoor physical activity in the natural environment for parentally-bereaved young people. It draws on data generated from a two-year ethnographic study that focused on the experiences of those involved with the Rocky Centre, a childhood bereavement service in the UK. Data was collected via extended periods of participant observation and semi-structured interviews with both staff and service users. One of the key themes to emerge from the analysis was that of physical activity in different environments. The meanings that the parentally-bereaved young people attributed to outdoor physical activity clustered around four sub-themes. These were: sense of freedom; distraction/escapism; retaining memories; and family cohesion. Each of these are considered in detail and their implications for future practice and research are discussed.

Objective. To (1) examine the subjective experience of parenting stress as a mediator between 2 distal stressors (sociodemographic risk and global psychological maladjustment), and examine the parenting of methadone-maintained mothers, and (2) identify maladaptive and adaptive parenting correlates of specific types of parenting stress. Design. We analyzed baseline data from interviews conducted with 74 methadone-maintained mothers who expressed interest in a randomized clinical trial study testing the efficacy of a relational parenting intervention. Baseline measures included questionnaires on maternal psychological maladjustment, parenting stress, parenting problems, and children's maladjustment. Three series of hierarchical linear regressions were conducted to test the mediation model and specificity of associations. Results. Parenting stress mediated the associations between sociodemographic risk and 2 maladaptive parenting domains (aggression and neglect) and between psychological maladjustment and all 5 parenting domains examined (aggression, neglect, affective interactions, limit setting, and autonomy), although correlations were modest. Child-focused stress was associated with higher levels of aggression, limit-setting problems, and restricted autonomy. Stress derived from the mother - child relationship was associated with higher levels of neglect and affective withdrawal. Conclusions. Although preliminary in nature, results of this study indicate the importance of understanding the role of internal mechanisms (e.g., parenting stress) in the parenting processes of addicted women and examining specific correlates of their parenting problems.

Since the release of the 1997 MetLife Study of Employer Costs for Working Caregivers, new research has helped us better understand the issues facing employed caregivers and their employers, new workplace programs have been developed and
more employees are reporting involvement in eldercare. In 2004, the National Alliance for Caregiving and AARP issued the findings of a survey of U.S. caregivers which forms the basis of this update of the costs to employers of caregiving employees.1 Findings are based on a Level of Burden Index, with Level 1 being the lowest in caregiving intensity and level 5 being the highest. Intense caregivers (Levels 3 – 5) are defined as doing personal care tasks (such as bathing, dressing, feeding as well as other tasks) for an average of 12 to 87 hours per week; levels 1 and 2 are caregivers providing, on average, fewer than 10 hours of care per week of less intense tasks, such as taking someone to a doctor's appointment or doing housework for them. This study estimates the productivity losses to U.S. business of employees who must make workplace accommodations as a result of caregiving responsibilities. These include costs associated with replacing employees, absenteeism, crisis in care, workday interruptions, supervisory time, unpaid leave, and reducing hours from full-time to part time.Since the release of the 1997 MetLife Study of Employer Costs for Working Caregivers, new research has helped us better understand the issues facing employed caregivers and their employers, new workplace programs have been developed and more employees are reporting involvement in eldercare. In 2004, the National Alliance for Caregiving and AARP issued the findings of a survey of U.S. caregivers which forms the basis of this update of the costs to employers of caregiving employees.1 Findings are based on a Level of Burden Index, with Level 1 being the lowest in caregiving intensity and level 5 being the highest. Intense caregivers (Levels 3 – 5) are defined as doing personal care tasks (such as bathing, dressing, feeding as well as other tasks) for an average of 12 to 87 hours per week; levels 1 and 2 are caregivers providing, on average, fewer than 10 hours of care per week of less intense tasks, such as taking someone to a doctor's appointment or doing housework for them. This study estimates the productivity losses to U.S. business of employees who must make workplace accommodations as a result of caregiving responsibilities. These include costs associated with replacing employees, absenteeism, crisis in care, workday interruptions, supervisory time, unpaid leave, and reducing hours from full-time to part time.

Aim: The aim of this study was to explore situations in daily life that challenge caregivers' self-image when caring for a dying family member at home. Background: Caregiving affects the health and daily lives of family caregivers. Patterns of challenging situations may provide insight into the home caregiving experience, thus contributing to our understanding of the influence it has on the caregivers' self-image. Design: Qualitative descriptive study. Methods; Ten family caregivers who cared for a dying family member at home with support from an advanced home care team were interviewed 6–12 months after the death of the family member. The interviews were analysed with interpretive description. Result: Three patterns characterised the experiences of caregivers' daily lives in caring for a dying family member at home: challenged ideals, stretched limits and interdependency. These patterns formed the core theme, the modified self. Situations that challenged the caregivers' self-image were connected to experiences such as 'forbidden thoughts', intimacy and decreasing personal space. Conclusions: The caregivers met challenging situations in their daily lives that created a modified image of self. It is important to recognise the impact of caring for a dying family member at home. Relevance to clinical practice: This study argues for supporting family caregivers to maximise their potential to handle the demanding everyday life with a dying family member at home. This study contributes to understanding situations in the home that may challenge caregivers' self-image and points out the importance of talking about caregiving experiences. From a clinical perspective, this study emphasises the significance of creating a climate, which allows family caregivers to express thoughts and feelings. Sharing experiences such as 'forbidden thoughts' can be one way of handling the profoundly changed every day life.

We present a brief measure of caregiver burden, the Mood Disorder Burden Index (MDBI), for use with family members and close friends of adults with major depressive disorder (MDD) or bipolar disorder (BD). The MDBI assesses burden in three core domains (patients' mood symptoms, caregivers' worry about the future, and caregivers' interpersonal difficulties with the patient) and includes an optional module that assesses caregiver burden associated with patients' pharmacotherapy or psychotherapy. The MDBI was administered to caregivers of older individuals (i.e., 58 years and older) with MDD (n=123) or BD (n=38) who were receiving treatment through a research study. Analyses indicated evidence of convergent and discriminant validity of the new measure well as internal consistency within both caregiver groups. It will be important for future research to administer the MDBI to caregivers of middle-aged and older patients as well as those receiving treatment through inpatient settings or community outpatient clinics.

The purpose of this study was to develop an empirically derived multi-item scale of care tasks performed by young people in the context of family illness/disability: the Youth Activities of Caregiving Scale (YACS). A total of 135 youngsters aged 10-24 years with an ill/disabled family member completed questionnaires. Factor analyses performed on the YACS yielded four factors, instrumental care, social/emotional care, personal/intimate care and domestic/household care, accounting for 57.78% of the variance. The internal reliabilities of all factors ranged from 0.74 to 0.92. Higher scores on the YACS related to higher youth age and several caregiving context variables (i.e. household type [single or dual-parent household], relationship with care-recipient and perceived choice in caregiving). Higher scores on the YACS also related to care-recipient illness/disability variables (onset, functional impairment, prognosis, predictability and illness/disability type). Strong positive correlations between the YACS and a conceptually related measure of young caregiving experiences provided good convergent validity data. Criterion validity was established with evidence that the YACS predicted youth adjustment in the domains of health and prosocial behaviour.

The purpose of this study was to develop an empirically derived multi-item scale of care tasks performed by young people in the context of family illness/disability: the Youth Activities of Caregiving Scale (YACS). A total of 135 youngsters aged 10-24 years with an ill/disabled family member completed questionnaires. Factor analyses performed on the YACS yielded four factors, instrumental care, social/emotional care, personal/intimate care and domestic/household care, accounting for 57.78% of the variance. The internal reliabilities of all factors ranged from 0.74 to 0.92. Higher scores on the YACS related to higher youth age and several caregiving context variables (i.e. household type [single or dual-parent household], relationship with care-recipient and perceived choice in caregiving). Higher scores on the YACS also related to care-recipient illness/disability variables (onset, functional impairment, prognosis, predictability and illness/disability type). Strong positive correlations between the YACS and a conceptually related measure of young caregiving experiences provided good convergent validity data. Criterion validity was established with evidence that the YACS predicted youth adjustment in the domains of health and prosocial behaviour. (PsycINFO Database Record (c) 2012 APA, all rights reserved) (journal abstract)

Background: Few reports have been published about differences in perspectives on perceived needs among community-residing people with dementia, their family caregivers, and professionals. The aim of this study was to compare these perspectives. Method: During 2006 and 2007, one-hundred and fifty two interviews of people with dementia and their caregivers about the needs of the person with dementia were performed by four professionals using The Camberwell Assessment of Need for the Elderly (CANE). Professionals' views on met and unmet needs of people with dementia were obtained for the total sample, family caregivers' perspectives were gained for 125 people with dementia, and people with dementia's views on their own needs were obtained for 125 persons with dementia. Results: People with dementia reported fewer needs compared with the reports of their caregivers and the professionals. The most frequent unmet needs reported by people with dementia, caregivers and professionals were in the areas of daytime activities, company, and psychological distress; however, people with dementia rated psychological distress as the commonest unmet need. Conclusions: Since the priorities of people with dementia can be different from those of caregivers and professionals, it is important to consider all perspectives when making care plans. Thus, compliance with treatment of people with dementia and also their quality of life could be potentially improved by a more collaborative partnership with them.

Background: The concept of family quality of life is becoming increasingly important in family support programmes. This concept describes the quality of life of all family members and the family system as a whole, but only the opinion of the parents has been included. The opinion of the siblings has been incorporated in the opinions of the parents, although research has shown that there is discordance between parents' and siblings' reports. The principal goal of this study is to investigate how young siblings of children with intellectual disability define their quality of life as a sibling. Method: As we were more concerned with understanding the experience of being a sibling from the siblings' own frame of reference, we opted for a qualitative research design and more specifically used in‐depth, phenomenology‐based interviews. Data were sorted by means of a process of continuously comparing the codes according to the principles of grounded theory. Results: Siblings described the following nine domains as domains of sibling quality of life: joint activities, mutual understanding, private time, acceptance, forbearance, trust in well‐being, exchanging experiences, social support and dealing with the outside world. Conclusions: This study shows not only that siblings can define their quality of life, but also that this definition of sibling quality of life differs from the family quality of life concept. Therefore, it may be not only a valuable addition to the family quality of life concept but also an appropriate concept to describe siblings' experience. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)

OBJECTIVE:
To examine the co-occurrence of witnessing partner violence with child maltreatment and other forms of victimization.
METHOD:
Data are from the National Survey of Children's Exposure to Violence (NatSCEV), a nationally representative telephone survey of the victimization experiences of 4,549 youth aged 0-17.
RESULTS:
Witnessing partner violence (WPV) is very closely associated with several forms of maltreatment and exposure to other forms of family violence in this sample, with adjusted OR ranging from 3.88 to 9.15. WPV is also significantly associated with a wide variety of other forms of victimization, with OR ranging from 1.43 to 7.32. More than 1/3 (33.9%) of youth who witnessed partner violence had also been maltreated in the past year, compared with 8.6% of non-witnesses. For lifetime data, more than half (56.8%) of WPV youth had also been maltreated. Neglect and custodial interference were most closely associated with WPV.
CONCLUSIONS:
These data support the poly-victimization model, indicating that many youth experience multiple forms of victimization. They also indicate that the various forms of family violence are especially closely linked.
PRACTICE IMPLICATIONS:
These results provide new urgency to calls to better integrate services to adult and child victims of family violence. For example, screening to identify the needs of child witnesses could be done in domestic violence shelters, and screening to identify the needs of adult victims could be done in child protective service settings.

OBJECTIVES:
The American Academy of Pediatrics recommends a medical home for children with special health care needs (CSHCN). In the Pediatric Alliance for Coordinated Care (PACC), 6 pediatric practices introduced interventions to operationalize the medical home for CSHCN. The intervention consisted of a designated pediatric nurse practitioner acting as case manager, a local parent consultant for each practice, the development of an individualized health plan for each patient, and continuing medical education for health care professionals. The objectives of this study were 1) to characterize CSHCN in the PACC, 2) to assess parental satisfaction with the PACC intervention, 3) to assess the impact on hospitalizations and emergency department episodes, and 4) to assess the impact on parental workdays lost and children's school days lost for CSHCN before and during the PACC intervention.
METHODS:
A total of 150 CSHCN in 6 pediatric practices in the Boston, Massachusetts, area were studied. Participants were recruited by their pediatricians on the basis of medical/developmental complexity. Physicians completed enrollment information about each child's diagnosis and severity of condition. Families completed surveys at baseline and follow-up (at 2 years), assessing their experience with health care for their children.
RESULTS:
A total of 60% of the children had >5 conditions, 41% were dependent on medical technology, and 47% were rated by their physician as having a "severe" condition. A total of 117 (78%) families provided data after the intervention. The PACC made care delivery easier, including having the same nurse to talk to (68%), getting letters of medical necessity (67%), getting resources (60%), getting telephone calls returned (61%), getting early medical care when the child is sick (61%), communicating with the child's doctor (61%), getting referrals to specialists (61%), getting prescriptions filled (56%), getting appointments (61%), setting goals for the child (52%), understanding the child's medical condition (56%), and relationship with the child's doctor (58%). Families of children who were rated "severe" were most likely to find these aspects of care "much easier" with the help of the pediatric nurse practitioner. Satisfaction with primary care delivery was high at baseline and remained high throughout the study. There was a statistically significant decrease in parents missing >20 days of work (26% at baseline; 14.1% after PACC) and in hospitalizations (58% at baseline; 43.2% after PACC). The approximate cost per child per year of the intervention was 400 dollars.
CONCLUSIONS:
The PACC medical home intervention increases parent satisfaction with pediatric primary care. Those whose needs are most severe seem to benefit most from the intervention. There are some indications of improved health as well as decreased burden of disease with the intervention in place. The PACC model allows a practice to meet many of the goals of serving as a medical home with a relatively small financial investment.

The purpose of the study was to understand the impact of chronic disability on the functional ability of older adults. Thirty older adult participants and their caregivers were asked to identify which instrumental activities of daily living (IADL) are most meaningful and how their disability affected performance. Data collected through individual analysis indicated that the most important IADL tasks were driving and managing medication. Both older adult participants and their caregivers similarly perceived the health condition as significantly affecting the performance of all of the IADLs. However, there was a difference in the perception of the prior level of functioning for managing medication (z = 2.45, p = .024) and phone use (z = 2.26, p = .014). Results arrived at, and to be discussed, were in agreement with previous research findings indicating that complex tasks of daily living, particularly driving, are significant to the older adult's quality of life.

A variety of strategies have been used to help children with autism acquire functional communication skills. The Picture Exchange Communication System (PECS) is a unique communication training program that was developed as a means of circumventing some shortcomings associatd with these strategies. A description of the steps within PECS is provided. Long-term group data have indicated that a large proportion of children started on PECS as preschoolers acquire speech. Individual and group data supporting the use of PECS are provided.

A variety of strategies have been used to help children with autism acquire functional communication skills. The Picture Exchange Communication System (PECS) is a unique communication training program that was developed as a means of circumventing some shortcomings associatd with these strategies. A description of the steps within PECS is provided. Long-term group data have indicated that a large proportion of children started on PECS as preschoolers acquire speech. Individual and group data supporting the use of PECS are provided.

The PLUS Nursing Intervention, which is aimed at caregivers of elderly persons with depression and designed to increase caregiver personal resources, respond to caregiver learning/skill development needs, address caregiver unanticipated needs, and assist with caregiver stress/illness management, was pilot tested for efficacy. Thirteen families were assigned to the PLUS group and 12 families to the standard home care control group. There were no significant outcome differences between the two groups. However, caregivers who received the PLUS intervention made significantly more improvements over Standard Home Care caregivers when patients made functional improvements. Findings suggest that patient functioning might be a better predictor of long-term caregiver outcomes than psychiatric symptoms.

Abstract
OBJECTIVES:
To measure the prevalence of maltreatment and other types of victimization among children, young people, and young adults in the UK; to explore the risks of other types of victimization among maltreated children and young people at different ages; using standardized scores from self-report measures, to assess the emotional wellbeing of maltreated children, young people, and young adults taking into account other types of childhood victimization, different perpetrators, non-victimization adversities and variables known to influence mental health.
METHODS:
A random UK representative sample of 2,160 parents and caregivers, 2,275 children and young people, and 1,761 young adults completed computer-assisted self-interviews. Interviews included assessment of a wide range of childhood victimization experiences and measures of impact on mental health.
RESULTS:
2.5% of children aged under 11 years and 6% of young people aged 11-17 years had 1 or more experiences of physical, sexual, or emotional abuse, or neglect by a parent or caregiver in the past year, and 8.9% of children under 11 years, 21.9% of young people aged 11-17 years, and 24.5% of young adults had experienced this at least once during childhood. High rates of sexual victimization were also found; 7.2% of females aged 11-17 and 18.6% of females aged 18-24 reported childhood experiences of sexual victimization by any adult or peer that involved physical contact (from sexual touching to rape). Victimization experiences accumulated with age and overlapped. Children who experienced maltreatment from a parent or caregiver were more likely than those not maltreated to be exposed to other forms of victimization, to experience non-victimization adversity, a high level of polyvictimization, and to have higher levels of trauma symptoms.
CONCLUSIONS:
The past year maltreatment rates for children under age 18 were 7-17 times greater than official rates of substantiated child maltreatment in the UK. Professionals working with children and young people in all settings should be alert to the overlapping and age-related differences in experiences of childhood victimization to better identify child maltreatment and prevent the accumulative impact of different victimizations upon children's mental health.

BACKGROUND:
It is unclear what the impact of parental ADHD is on the day-to-day life of the rest of the family and how it contributes to the intergenerational transmission of this disorder.

METHOD:
The psychosocial functioning of 23 spouses and 63 children of 33 families with an ADHD parent and 20 spouses and 40 children of 26 comparison families was examined. Both adults and their spouses were assessed for lifetime and current Axis I and Axis II diagnoses, present general psychiatric symptoms and their marital relationships. Children were screened for ADHD and other problems, using the C-DISC, CBLC, TRF and the Social Adjustment Inventory.

RESULTS:
Children with an ADHD parent had higher rates of psychopathology than those from comparison families. Children with ADHD had more co-morbidities than non-ADHD children. Family and marital functions were impaired in ADHD families regardless of the gender of the affected parent. Children without ADHD from families with one psychiatrically healthy parent did well while the behaviour of children with ADHD was always poor and not associated with parental mental health.

CONCLUSION:
The results underscore the strong genetic contribution to ADHD and the need to carefully assess the non-ADHD parent as they seem to influence the well-being of non-ADHD children in families with an ADHD parent.

IMS AND OBJECTIVES:
This study had two aims. The first aim was to compare attachment styles and traumatic childhood experiences of women with psychiatric disorders and their children to a control group. The second aim was to determine the relationship between attachment styles and traumatic childhood experiences both in mothers and their children.

BACKGROUND:
According to attachment theories, trauma in an early relationship initiates a developmental cascade in which insecure attachments may occur.

DESIGN:
A cross-sectional, descriptive study which, employed a case-control design, was performed between May 2013-March 2014.

METHODS:
This study was conducted in 63 women with psychiatric disorders and their children. The control group consisted of 63 women without any psychiatric disorders and their children. Data were collected using questionnaire forms, including the Adult Attachment Style Scale and the Childhood Trauma Questionnaire for both mothers and children. Descriptive statistics, a Pearson correlation and comparative statistics were used to analyse data.

RESULTS:
The childhood trauma scores of both the women with psychiatric disorders and their children were higher than the control group scores. Compared to the control group, the mothers with psychiatric disorders and their children were found to have less secure attachment styles. It was determined that the mothers and children with insecure attachment were more likely to have been abused.

CONCLUSION:
These results point to a relationship between trauma in childhood and attachment style. They also suggest that this relationship may undergo intergenerational transfer.

RELEVANCE TO CLINICAL PRACTICE:
This study contributes to the existing literature on the relationship between childhood traumas and attachment. Psychiatric nurses should focus not only on psychiatric disorders but also on the difficulties a patient faces regarding being a parent.

Prior research has established that violence in dating relationships is a serious social problem among adolescents and young adults. Exposure to violence during childhood has been linked to dating violence victimization and perpetration. Also known as the intergenerational transmission of violence, the link between violence during childhood and dating violence has traditionally focused on physical violence. This research examines the relationship between experiencing and perpetrating dating violence and exposure to violence in the family of origin. Specifically, the current research examines gender differences in the relationship between exposure to violence during childhood and physical and psychological abuse perpetration and victimization. Data were collected from a sample of approximately 2,500 college students at two southeastern universities. Findings indicate that childhood exposure to violence is a consistent predictor of involvement in relationships characterized by violence for males and females. The implications of the current research on policy are discussed.

This article examines the relationship between job and elder caregiving involvement, bi-directional work-caregiving conflict (work interfering with caregiving [WIC] and caregiving interfering with work [CIW]), and work costs (job interruptions and job changes). Specifically, we consider the effects of both behavioral and psychological involvement and external and internal work caregiving conflict in a sample of 583 women between the ages of 50 and 64 who work full-time and have significant elder caregiving responsibilities. A telephone survey was administered using random-digit-dial procedures. Structural equation model analyses confirmed that behavioral job involvement was associated with external CIW, psychological job involvement was associated with internal WIC and internal CIW, behavioral caregiving involvement was associated with external CIW and work costs, and psychological caregiving involvement was associated with internal CIW. Internal WIC, external CIW, and internal CIW were associated with job costs. Some mediation, particularly through external and internal CIW, occurred.

Purpose. To describe a measure and its performance specific to the relationship of personal factors and subjective well-being (SWB) to the use of assistive technology devices (ATDs). The primary hypothesis is that responses to a 33-item personal factors scale and a 12-item SWB scale are good indicators of an individual's predisposition for using, and subsequent match with, a given ATD.
Methods. Data analyses from a number of studies using the 33-item personal factors and the 12-item SWB scales of the Assistive Technology Device Predisposition Assessment with persons of various ages and types of disabilities.
Results. Regardless of type of disability or age of respondent, the ATD PA personal factors and the SWB scales identified important differences in predispositions to use an ATD as well as the subsequent quality of the match of person and device.
Conclusions. A quantifiable relationship exists between the ATD PA's measure of personal factors and the SWB such that it is possible to characterise an individual's predisposition to use a particular ATD. Results also show that the scales are predictive of the quality of the ATD and user match at follow-up. Rehabilitation practitioners who use the ATD PA may achieve enhanced assistive technology service delivery outcomes by using this evidence-based measure.

A narrative story-stem task was used to evaluate the efficacy of two competing, developmentally informed preventive interventions for maltreated preschoolers and their mothers designed to modify children's internal representations of self and of self in relation to other. One hundred and twenty-two mothers and their preschoolers (87 maltreated and 35 nonmaltreated) served as participants. Maltreating families were randomly assigned to either the preschooler-parent psychotherapy (PPP, n = 23), psychoeducational home visitation (PHV, n = 34), or community standard (CS, n = 30) intervention group at baseline. Thirty-five nonmaltreating (NC) families served as comparisons. Narratives were administered to children at baseline and at the postintervention evaluation. Children in the PPP intervention evidenced more of a decline in maladaptive maternal representations over time than PHV and CS children and displayed a greater decrease in negative self-representations than CS, PHV, and NC children. Also, the mother-child relationship expectations of PPP children became more positive over the course of the intervention, as compared to NC and PHV participants. These results suggest that an attachment-theory informed model of intervention (PPP) is more effective at improving representations of self and of caregivers than is a didactic model of intervention directed at parenting skills. Findings are discussed with respect to their implications for developmental theory, with a specific focus on attachment theory and internal working models of relationships.

This paper reviews one aspect, impact, of the forthcoming assessment of research in UK universities, the Research Excellence Framework (REF), and examines its meaning and potential for enhanced partnerships between social work practice and academia in the context of the current economic crisis. Examples of case studies being developed to show how research has societal impact are described and some of the complexities of what, on the surface appears to echo social work's desire to make a positive difference to the Lives of people in society, are drawn out. The importance of the REF for the integration of social work practice and academia has been rehearsed many times. This paper argues that making an impact is everybody's concern and practitioners and those who use social work services and their carers have a role to play in its creation and identification.

Several studies of frail older people have focused on the relationship between formal and informal care, while others have examined the character of inter-generational relationships. Yet knowledge of the significance of the informal-support networks of older people who receive formal care is still scarce. The aim of this paper was to explore how older Swedes who receive formal elder-care experienced their informal support networks. The findings presented emanate from a qualitative case study. The structural, interaction and functional dimensions of the support networks were the main analytical tools. In the study population, the size of the formal support network varied from one to 12 people (or categories of people), and the size of the informal support network varied from one to six people (or categories of people). The main results demonstrate the importance of informal support with reciprocal relationships, and the value of confidants and emotional support, both of which contribute to feelings of belonging, security and wellbeing. A well-functioning formal and informal support network allows individuals to maintain autonomy in old age, even when they have to depend on help from others

Longitudinal studies of children of alcoholics in a community context are rare, but are of special interest because they provide the opportunity to study families with alcoholic parents who do not reach clinical settings and with offspring who do not receive professional help. The current study reports on the 65 offspring of alcoholics who participated in the Kauai Longitudinal Study. The extensive data on these analyses included questionnaires and interviews of both children and adults that were collected over a 30-year period. The data showed that individuals who coped effectively with the trauma of growing up in an alcoholic family and who became competent adults relied on a significantly larger number of sources of support in their childhood and youth than did the offspring of alcoholics with coping problems by age 32.

The aim of the study was to investigate the role of community mental health nurses in educating clients and families about schizophrenia. A random sample of community mental health nurses was surveyed using a postal questionnaire. Results showed that most nurses did not use a specific approach for education. Families were educated when clients were admitted to hospital and clients were included when they regained the ability to process information. All nurses provided practical advice to families coping with clients' unpredictable behaviours. The client's home was mostly used for education. Clients and families were often in denial of the illness. Time constraints restricted the nurses' role of providing education. Nurses reported that psycho-educational theories or models were not incorporated into their basic professional education. Nurses require the necessary knowledge, skills and confidence to competently perform this role

The role of ethnicity in care of elderly Finnish immigrants Most Western countries are becoming increasingly multicultural because of immigration. Many of these immigrants grow old in a second homeland and will need health and elderly care in the future. In Sweden, the largest immigrant group comes from its neighbouring country, Finland. Little is known about how this group experiences present health care or their expectations of future elderly care. The overall aim of the thesis was to describe and to deepen the understanding of elderly Finnish immigrants experiences of health care and elderly care and the role that ethnicity played in these experiences. The specific aims were to: elucidate the elderly Sweden-Finns experiences and beliefs about health care in Sweden, in order to gain an understanding of how ethnic background affects the elderly immigrated persons experiences and beliefs in the host country (I); illuminate the role that culturally appropriate care plays in relation to the elderly Finnish immigrants wishes and expectations of institutional elderly care (II); describe and compare the elderly Finnish immigrants perceptions of health care, both among those who have continued to live in Sweden and those who have re-migrated to Finland (III); describe the cultural adjustments that had been made at a specific elderly care setting, the Finnish Home, and illustrate the impact of cultural adjustments on care, as conditions that promoted the well-being of the residents (IV). All the participants were born in Finland and Finnish was their native language and they lived (I-II and IV) or had lived in Sweden. In I-II, the 39 participants were 75 years or older and in III-IV, 65 years or older. In III, 217 persons participated in Finland, and 643 persons participated in Sweden. All residents, staff and visitors of Finnish Home participated in IV. Qualitative interviews were conducted in the participants homes (I-II), a mailed questionnaire was used in Study III, and an ethnographic study design was used in Study IV. Several different analysis methods were used: Hermeneutical ad hoc analysis (I), latent content analysis (II), statistical analysis (III), and an ethnographic method (IV). The results show that the Swedish health care system is congruent with the elderly Finnish immigrants expectations (I), and their experiences of care were good (III). Their experiences of the Finnish health care system were also good (III). However, sharing the same ethnic background as the care providers was believed to lead to better care (I). When thinking about future elderly care, the elderly Finnish immigrants wished to feel familiarity, continuity in life, security, and companionship. This could be achieved either in the well-known physical environment of their current homes, in an elderly care setting in their part of town, or in a well-known socio-cultural environment at an elderly care setting where Finnish was spoken and the care providers and fellow-residents were Finns (II). When being cared for in a culturally adjusted elderly care setting, the care became culturally congruent as the care providers, and the residents played the same language and ethnicity game (IV). The conclusions from the thesis show that ethnicity and ethnic identity, a shared mother language, and the place, play an important role in the care of elderly Finnish immigrants. In addition to this, the elderly Finns experienced a feeling of at-homeness when being cared for by members of their own ethnic group, in a familiar place, with people who spoke the same native language.

BACKGROUND:
Research suggests that children exposed to parental drinking problems are at risk for maladjustment. However, the potential impact of drinking problems in a community sample and the processes involved in the relationship between parental drinking and child outcomes have rarely been examined.
METHOD:
A community sample of 235 mothers and fathers of kindergarten children completed measures of problem drinking symptoms, family functioning and child adjustment.
RESULTS:
Model tests indicate that problem drinking was associated with greater marital conflict, and that marital conflict was related to ineffective parenting which was in turn related to poorer child adjustment.
CONCLUSIONS:
Even in a community sample, parental problem drinking behaviors are associated with reduced family functioning that relates to child outcomes.

Background:  Research suggests that children exposed to parental drinking problems are at risk for maladjustment. However, the potential impact of drinking problems in a community sample and the processes involved in the relationship between parental drinking and child outcomes have rarely been examined.

Method:  A community sample of 235 mothers and fathers of kindergarten children completed measures of problem drinking symptoms, family functioning and child adjustment.

Results:  Model tests indicate that problem drinking was associated with greater marital conflict, and that marital conflict was related to ineffective parenting which was in turn related to poorer child adjustment.

Conclusions:  Even in a community sample, parental problem drinking behaviors are associated with reduced family functioning that relates to child outcomes.

This study investigated the extent to which parental Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms impact child and parent outcomes following a multimodal family-school intervention, the Family School Success (FSS) program, when compared to an active-control condition (CARE). Participants were 139 children with ADHD (67% male; 91% non-Hispanic; 77% Caucasian; Grades 2-6) and their primary caretaker (91% female; ages 26-59) who participated in a randomized clinical trial evaluating the efficacy of FSS. Associations were examined between parent-reported ADHD symptoms at baseline and intervention outcomes reported by parents and teachers after treatment and at a 3-month follow-up, including child homework and classroom impairments, child ADHD and oppositional defiant disorder symptoms, parenting behaviors, and parent-teacher relationship quality. Across both treatment conditions, parental ADHD was not associated with parent or child outcomes at postassessment. However, differences emerged between the two treatment groups at follow-up for parents with ADHD, particularly when an empirically supported symptom cutoff was used to identify parents at risk for having ADHD. In FSS, but not in CARE, parental ADHD was associated with declines in treatment gains in the quality of the parent-teacher relationship and the child's homework performance. Parents at risk for ADHD had difficulty maintaining treatment effects for themselves and their child in the FSS intervention but not in CARE. The supportive and educational components central to the CARE intervention may be helpful in promoting the sustainability of psychosocial interventions for children with ADHD who have parents with elevated ADHD symptoms.

This article reviews current knowledge concerning the relationship between peer support and adjustment outcomes and experiences for parentally bereaved children. A brief overview of the effects of parental bereavement and factors influencing immediate and long-term adjustment is provided, followed by an overview of peer-provided social support and its relationship to adjustment. Current findings on the predictive value of peer support for adjustment are then discussed, with emphasis on the reciprocal positive and negative influences that peer support and adjustment (or lack thereof) exert. Areas of weakness and neglect within this domain are noted, with a focus on methodological issues, peer-relevant consequences of bereavement in need of further research, and the need for study of particular vulnerable subgroups.

Objective: This study investigated the role that social support plays in well-being and in coping after a stressful event in a group of non-clinical adolescents. Furthermore, this study aimed at replicating the finding that adolescents who reported sexual abuse reported more symptoms and less adequate coping strategies than adolescents who reported another type of stressful event or no stressful episode.

Method: Eight hundred and twenty adolescents between 12 and 18 years of age filled out questionnaires assessing social support (Social Support Questionnaire, Sarason, Shearin, Pierce, & Sarason, 1987), trauma-related symptoms (Trauma Symptom Checklist for Children, Briere, 1996), behavior problems (Youth Self-Report, Achenbach, 1991), and coping (How I Cope Under Pressure Scale, Ayers, Sandler, West, & Roosa, 1996).

Results: 42% of the adolescents reported a stressful experience, and 4.4% reported sexual abuse. Sexually abused adolescents reported more stress-related symptoms and used more avoidance and fewer support-seeking coping strategies than the other adolescents. The main-effect hypothesis of social support was sustained, but social support did not moderate the relation between a stressful event and coping. Yet, a trend was found suggesting that high support from the family was associated with less avoidance coping and more support-seeking in adolescents who reported a non-sexually abusive, stressful event.

Conclusions: Our findings show that a highly perceived availability of social support is directly associated with fewer trauma-related symptoms, especially in adolescents who are non-sexually abused. For adolescents who reported a sexual or another type of stressful event, social support did not play a different role in coping.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

Sammanfattning
En hög andel barn har någon gång under sin uppväxt i sin familj missbruk/beroende, psykisk ohälsa eller funktionsnedsättning, våld, allvarlig sjukdom eller skada eller någon som avlider. Ofta är svårigheterna överlappande. Det är ett grundläggande folkhälsoarbete att genom adekvat stöd förebygga de väl dokumenterade riskerna för negativa konsekvenser av en sådan uppväxt, i barnens vardag här och nu och för deras framtid. Ett omfattande utvecklingsarbete har utifrån regeringsuppdragen bedrivits under hela perioden 2011–2020, i nära samarbete med andra nationella och regionala aktörer. Steg har tagits närmare målet att barn inte ska skadas av föräldrars missbruk och beroende och att psykisk ohälsa av familjerelaterade orsaker minskar hos barn och unga. Detta har skett bland annat genom att stödja både hälso- och sjukvård och socialtjänst i att genom ökad kunskap och skapandet av hållbara strukturer tillämpa ett barn-, föräldraskaps- och familjeperspektiv i arbetet med dessa familjer. Stödet har bestått i framtagande och publicering av kunskapssammanfattningar och olika former av webbstöd, spridande av verksamma arbetssätt, stöd till utvecklingsarbeten samt anordnande av konferenser och lärande nätverk. Detta påverkans- och utvecklingsarbete är viktiga insatser för att minska de påverkbara hälsoklyftorna i samhället. Arbetet är också en utmaning som kräver långsiktighet och kontinuerligt stöd för implementering. Fortsatta kontinuerliga insatser behövs för att alla som i sitt arbete möter föräldrar med egna svårigheter uppmärksammar barnens situation och ger dem information, råd och stöd efter behov. Medvetenheten om professionens ansvar att förhålla sig till patienter, brukare och klienter som föräldrar, och till deras barn som anhöriga och rättighetsbärare, behöver öka inom såväl hälso- och sjukvården som socialtjänsten. Barnkonventionen som lag stärker arbetet, men kräver fortsatta insatser för efterlevnad i praktiken. I denna redovisning lyfts därför behovet av att ett fortsatt nationellt stöd inom området behövs. Det stödet omfattar fortsatt arbete med uppföljning, utveckling av ett samordnat familjeorienterat arbetssätt inom socialtjänsten och hälso- och sjukvården, stödstrukturer för barn i akuta situationer, samlad kompetens och ansvar för barn som föds med skador till följd av exponering av alkohol under fosterlivet samt nationellt samordning inom flera områden, exempelvis i arbetet med våld mot barn. Det är angeläget att den kommande ANDT-strategin från 2021 och framåt fortsatt särskilt lyfter behovet av satsningar på barn och stöd i föräldraskap för att se till barns behov av en trygg uppväxt här och nu samt förebygga missbruk och psykisk ohälsa i nästa generation.

Hur är det att vara anhörigtill en person med demenssjukdom? Vilket stöd ges från sam-hällets sida och överensstämmer det med de verkliga behoven? Hur upplever vårdpersonaloch biståndshandläggare det är att stödja anhöriga? Var finns problemen, och hur ska vigöra för att lösa dem? Det är några av de frågor vi har ställt och försöker ge svar på i dennafokusrapport. Demens beskrivs ofta som de anhörigas sjukdomeftersom de förändringar som följer medsjukdomsutvecklingen starkt påverkar livskvaliteten även för de anhöriga. De anhöriga, somofta själva är äldre, har en avgörande roll när det gäller vården av personer med demens-sjukdom.1Invanda mönster och maktförhållanden förändras i en familj när någon insjuknari demenssjukdom.2Att vårda en närstående är vanligt i åldrarna 75 till 84 år, ungefär likamånga män som kvinnor.3Att vara anhörig till en person med demenssjukdom påverkar hälsa, social situation, eko-nomi, livskvalitet och levnadsvillkor i hög grad.Ett flertal studier visar att anhöriga somvårdar en person med Alzheimersjukdom löper en ökad risk för depression4. Data från stu-dier visade att inflyttningen på särskilt boende kan framflyttas med sex månader om anhö-riga erbjuds stöd och hjälp när den demenssjuka fortfarande bor hemma. Välinformeradeoch kunniga anhöriga är en tillgång för både landsting och kommun. Från den 1 juli 2009 är kommunens skyldighet att ge stöd till anhöriga förtydligad genomen ändring i socialtjänstlagen. Kommunal hälso- och sjukvård och socialtjänst ska er-bjuda ett individuellt anpassat stöd till anhöriga, men också arbeta för att se, respektera ochsamarbeta med anhöriga.6Landstinget har ingen uttalad skyldighet att stödja anhöriga men har i uppdrag att svara förförebyggande hälso- och sjukvård enligt 2 c § Hälso- och sjukvårdslagen. Det innebärbland annat att identifiera personer eller grupper som riskerar att drabbas av ohälsa. Hälso-och sjukvården har en otydlig roll i dagens anhörigstöd. Sedan 2010 finns bestämmelser i hälso- och sjukvårdslagen och socialtjänstlagen att närbehov finns ska en gemensam individuell plan upprättas för personer med psykiska funk-tionsnedsättningar. Planeringen ska göras tillsammans med patient och anhöriga.De behov som anhöriga till personer med demenssjukdom har, liknar i stor utsträckning be-hoven som andra anhöriga har, det vill säga där det handlar om andra svåra kroniska sjuk-domar eller psykiska funktionshinder. Nästan oavsett vilka sjukdomstillstånd det handlar om innebär vardagen som anhörig ett stort antal utmaningar där samhället måste erbjudastöd och hjälp. I Socialstyrelsens "Nationella riktlinjer för vård och omsorg vid demenssjukdom 2010"belyses hela vårdkedjan - över huvudmannaskapsgränserna. I riktlinjerna framgår hur deolika aktörerna bör strukturera sitt arbete för att kunna säkra god och jämförbar vård förpersoner med demens. I de nationella riktlinjerna lyfts begreppet personcentrerad omvårdnadfram, det vill sägaatt omhändertagandet av personer med demenssjukdom i möjligaste mån ska individanpas-sas. Flertalet anhöriga anser att personal inom vård och omsorg inte tar tillvara anhörigaskunskap om deras närstående. För att lyckas med det krävs att företrädare från kommuneroch landsting betraktar anhöriga som samarbetspartners. På så sätt ökas självkänslanhos anhöriga och främjar deras självständighet. Det bidrar också till att man inom kommunoch landsting får en korrekt bild av vad som behövs i ett fungerande anhörigstöd.Olika typer av tekniska hjälpmedel kan även vara till stor hjälp för den anhöriga och bevaraden demenssjuke personens oberoende så länge som möjligt. Idag förskrivs sällan hjälpme-del för patientgruppen med demenssjukdom.I denna fokusrapport redovisas en sammanställning av material insamlat från Socialstyrelsen,Länsstyrelsen i Stockholm, "Stiftelsen Äldrecentrum" och "Nationellt kompetenscentrumAnhöriga" samt en ny kartläggning bestående av fokusgruppsintervjuermed anhöriga,distriktssköterskor, biståndshandläggare och personal på minnesmottagningar i länet. Enkartläggning som visar att: -Anhöriga är i behov av mer stöd och avlastning än de i dagsläget erbjuds.- Många anhöriga tycker att det är svårt att veta vem de ska vända sig till för att få hjälp eftersom det finns flera huvudmän. - Det finns brist i kompetens hos personal som vårdar personer med demens.- Företrädare inom såväl kommun som landsting anser att det behövs en tydligare be-skrivning av vem som ansvarar för vad ifråga om personer med demens, samt en önskan om fler och bättre samverkansformer för att förhindra att personer med demens"faller mellan stolarna". - Vårdpersonal och biståndshandläggare uttrycker önskemålet om att det borde finnas en funktion/roll som är huvudansvarig för varje person med demenssjukdom, och somkan följa denna/denne genom hela vårdkedjan. Resultaten som presenteras i denna rapport är en sammanvägning av allt material somnämns ovan, dvs en analys av kartläggningens olika delmoment: litteraturgenomgång ochfokusgruppsintervjuer. FörbättringsområdenInformation och utbildning till anhörigaUtbildningsprogram till anhöriga kan minska stress och risk för såväl fysisk som psykiskohälsa, och öka deras förmåga att hantera beteendemässiga problem. Utbildning kan ges iform av kontinuerlig och strukturerad information om demenssjukdomar, bemötande ochvilket stöd samhället erbjuder till anhöriga. Utbildningen kan ges individuellt eller i grupp.Primärvården och distriktssjuksköterskan har en viktig roll i fråga om anhörigstöd som be-höver förtydligas särskilt med tanke på att strukturerad anhörigutbildning med psykosocialtstöd ännu inte är rutinförfarande.Såväl kommuner som landsting behöver ge tydligare information om hur ansvarsfördel-ningen ser ut på sina respektive webbplatser. Broschyrmaterial behöver också arbetas framför att finnas tillängligt på de platser där anhöriga och närstående vistas. Det finns flera pa-tient- och frivilligorganisationer som gör viktiga insatser för människor med demenssjuk-dom. Ett utvecklat samarbete med patientorganisationer är angeläget eftersom de har storkunskap inom området och arrangerar utbildningar och konferenser.Utveckling av stödformerStöd till anhöriga finns i olika former: avlösning i hemmet, dagverksamhet, tillfälligt bo-ende, nätverk, tekniska hjälpmedel, utbildning, psykosocialt stöd och hemtjänst. Det är vik-tigt att man fortsätter att utveckla stödformer av alla slag – men framförallt att de erbjudstill alla som har behov. När det gäller yngre personer med demenssjukdom behövs det flerplatser inom dagverksamhet.Tydligare ansvarsfördelningFör att demenssjuka och deras anhöriga ska ha en fungerande vardag behövs klarare lokalariktlinjer och tydligare rollfördelning mellan landsting och kommuner. Att det finns flerahuvudmän som ansvarar för patientgruppen är ett stort problem. Vård och omsorgsgivareinom Stockholms läns landsting och kommunerna behöver tillsammans arbeta fram en an-svarsfördelning förtydligad i lokala vårdprogram. Exempelvis bör stödet till anhöriga fin-nas med i uppdraget både för minnesmottagningarna och husläkarverksamheten så attverksamheterna stödjer varandra och vårdkedjan hänger ihop. Samordnande kontaktpersonSamtliga parter i vård- och omsorgsarbetet kring personer med demens och även anhöriga,efterlyser en samordnande kontaktperson som kan fungera som "spindeln i nätet", somskulle kunna sköta kontakterna mellan primärvård/landsting och omsorg/kommun. En mo-dell finns i Kalmar där distriktssjuksköterskan är processansvarig för utredningen. Ävenanhörigstöd ligger under distriktssköterskans ansvar, vilket innebär att hon anordnar utbild-ningsträffar för anhöriga. Innehållet i stödet omfattas av medicinsk information, bemötandeoch andra råd och tips. Vid utbildningsträffarna deltar även kommunens handläggare somger information om hjälpinsatserna och olika boendeformer. Gemensam vård och omsorgsplanering samt årlig uppföljningSedan 2010 finns bestämmelser i hälso- och sjukvårdslagen och socialtjänstlagen att närdet finns behov ska en gemensam individuell plan upprättas för personer med psykiskafunktionsnedsättningar. Planeringen ska göras tillsammans med patient och anhöriga för attbehoven av både hälso- och sjukvård och socialtjänst ska tillgodoses. Dokumentet skaockså beskriva de olika insatser och vårdgivarnas ansvar.Hälso- och sjukvården och socialtjänsten bör minst en gång per år följa upp sjukdomensförlopp och anpassa läkemedel, vård och omsorg. Då är det viktigt att föra ett enskilt sam-tal med den anhörige, dels för att följa upp om de beviljade stödformerna är tillräckliga,dels för att kontrollera om den anhöriga fortfarande har möjlighet och ork att vårda sin de-menssjuka närstående. Huruvida gemensamma individuella planer tas fram och årliga upp-följningar görs enligt ovan är okänt men mycket talar för att det inte sker i tillräckligomfattning.Förbättrad kompetensTrygghet är en viktig faktor i omhändertagandet av personer med demens och deras anhö-riga. Anhöriga önskar mer information, och att vård och omsorg utförs av yrkeskunnig per-sonal i sjukdomens alla skeden – från diagnos till palliativ vård, en period som ofta löperöver 5–7 år.Fortbildning för läkare, distriktssköterskor, arbetsterapeuter, biståndshandläggare, vård-och hemtjänstpersonal och andra är också nödvändigt för att öka förståelsen och kunskapenom det komplexa sjukdomstillstånd som demens är, och hur det drabbar de anhöriga. Ökad kompetens för alla yrkesgrupper som kommer i kontakt med demenssjuka, inomsåväl kommun som landsting, innebär att man kan identifiera risker på ett tidigt stadium.En effekt av detta blir att förhindrar kostsamma åtgärder senare i sjukdomsförloppet samtatt livskvaliteten hos patienterna och deras anhöriga förbättras. Fungerande hemvårdFör många äldre är stödet från en anhörig en förutsättning för att kunna bo kvar i det ordi-nära boendet.8För att anhöriga ska klara av detta krävande och mångfacetterande uppdragmåste det finnas ett utvecklat stöd från såväl landsting som kommun, vilket förutsätter ettfungerande samarbete mellan geriatrik, primärvård och äldreomsorg.9Hemvården bör ut-formas i samarbete med de anhöriga som är "experterna" i fråga om vilka behov närstå-ende i fråga har. För att erbjuda personer med demens och deras anhöriga bättre stöd skulleen utökad satsning på uppsökande verksamhet vara önskvärd, där de olika huvudmännentar ett gemensamt ansvar. Önskvärt är också att det skulle finnas ett fungerande multipro-fessionellt team för att möta behoven. Ett team som är mobilt och kan uppsöka den som ärsjuk, och inte tvärtom. Adekvat stöd och ersättningStödinsatser till anhöriga har en positiv effekt på deras hälsa vilket minskar landstingetskostnader på sikt.10Anhöriga som uttrycker önskan om att vårda närstående med demens-sjukdom behöver genom samhällets försorg få förutsättningar för detta, såväl i fråga omeko- nomi som hjälp med vård- och omsorgsinsatser till den sjuke. Inte minst med tanke påatt lejonparten av anhörigvårdarna själva tillhör gruppen äldre. Olika typer av tekniskahjälpmedel kan vara till stor hjälp för den anhöriga och bevara den demenssjuke personensoberoende så länge som möjligt. Idag förskrivs sällan sådana hjälpmedel för den här grup-pen. KvalitetsindikatorerAntalet nationella indikatorer för vård och omsorg för personer med demenssjukdom är 14stycken. Merparten är så kallade utvecklingsindikatorer - det vill säga indikatorer som inteär möjliga att kontinuerligt följa med de uppföljningssystem som finns i dagsläget.11Ingenindikator tar upp stödet till anhöriga. Det är önskvärt att man i framtiden skapar indikatoreräven för anhörigstöd. Registrering i och användningen av kvalitetsregistret SveDem bordegöras i större sträckning av vårdgivarna än som sker idag. Ekonomiska konsekvenserDe anhöriga svarar för den helt dominerande delen av närståendes omsorg och omvårdnadi eget boende. Att sjukvården ser anhöriga som en samarbetspartner och ger adekvat stöd ärpå sikt kostnadseffektivt för landstingets del. Konsekvenserna av otillräckligt stöd kan ledatill ökade kostnader och vårdkonsumtion för såväl patienter som anhöriga.

Magisteruppsats

Syftet med föreliggande studie var att skaffa fram ett underlag för att från habiliteringens sida
kunna vara ett adekvat stöd till professionella, när det gäller bemötande av föräldrar, särskilt
mammor, med intellektuella begränsningar.
För detta syfte behövde vi kartlägga de professionellas inställning och attityder till föräldrar
med intellektuella begränsningar, men också förmedla den bild som mammorna/föräldrarna
har på det stöd de får. I en kvalitativ studie intervjuades åtta mammor med intellektuella
begränsningar om deras syn på det stöd de får. En enkätstudie ställd till professionella gav
kännedom om olika verksamheters arbetssätt och utbud av stöd till familjer där en eller båda
föräldrarna har intellektuella begräsningar. I resultatdelen speglades informationen från
mammorna mot enkätsvaren.
Samverkansaspekter beaktades särskilt noga. Studien utgick från följande frågor:
Vilka erfarenheter och vilken inställning har de professionella till föräldrar med intellektuella
begränsningar? Hur kan mammornas egna synpunkter på den hjälp de får bidra till förståelse
för familjernas behov? Vilket stöd finns idag, hur skulle det eventuellt behöva förstärkas och
vilken roll kan habiliteringen ha?
De båda undersökningarna gav samstämmiga resultat när det gäller att beskriva
stödinsatsernas omfattning och mångfald. En annan aspekt som belystes från ömse håll var
behovet av utökat tidsutrymme för kontakt. Denna samstämmighet kunde utgöra grund för
fortsatt arbetsallians. Vi konstaterade vidare att det fanns behov av ett kunskapscenter som
kunde bidra till lättillgänglig information för både professionella och familjer. Professionella
uttryckte önskan om att lära mer avseende funktionshinder och dess konsekvenser särskilt i
kombination med föräldraskap. Behov av utökad och rutinmässig samverkan framkom mellan
de instanser som möter föräldrar med intellektuella begränsningar och deras barn. Slutligen
konstaterades en naturlig roll för habiliteringen, framför allt avseende fyra aspekter. Det
gällde förmedling av kunskap om funktionshinder, liksom insatser av preventiv art,
nätverksbyggande och samordnarfunktion.

Ett omfattande arbete har utförts i landets kommuner sedan slutet av 1990-talet för att utveckla stödet till anhöriga. I maj 2009 beslutade riksdagen att kommunerna ska "erbjuda stöd för att underlätta för de personer som vårdar en närstående som är långvarigt sjuk eller äldre eller som stödjer en närstående som har funktionshinder."

Studiens syfte är att kartlägga innehållet i stödet till anhöriga, hur stödet organiseras, planeras, följs upp och utvärderas inom äldre-, funktionshinder- och individ- och familjeområdet samt samverkan mellan kommun, landsting, ideella organisationer och andra aktörer inom området. I kartläggningen ingår även att undersöka hur de olika huvudintressenterna bedömer kvaliteten på stödet till anhöriga.

I undersökningen kartläggs och följs stödet till anhöriga under tre år i åtta kommuner. De studerade kommunerna är Borås, Härjedalen, Hässleholm, Malmö, Skara, Strängnäs, Uppsala och Västervik. I rapporten presenteras resultatet av kartläggningen för år 2010.

Rapporten är ett samarbete mellan FoU Sjuhärad Välfärd, FoU-stöd Regionförbundet Uppsala län, Fokus Kalmar län, FoU i Sörmland, Kommunförbundet Skåne, Malmö stad, Skaraborgs kommunalförbund, FoU Jämt, Nationellt kompetenscentrum anhöriga.

Regeringen har gett Socialstyrelsen i uppdrag att utarbeta en vägledning till stöd för
tillämpningen av lagstiftningen som rör socialtjänstens arbete med stöd till personer
som vårdar eller stödjer närstående. Som ett led i vägledningsarbetet ger Socialstyrelsen
ut meddelandeblad och broschyrer, tillhandahåller information och publicerar artiklar på
hemsidan "Fokus på anhöriga" samt medverkar vid nationella och regionala konferenser.

Regeringen har gett Socialstyrelsen i uppdrag att utarbeta en vägledning till stöd för
tillämpningen av lagstiftningen som rör socialtjänstens arbete med stöd till personer
som vårdar eller stödjer närstående. Som ett led i vägledningsarbetet ger Socialstyrelsen
ut meddelandeblad och broschyrer, tillhandahåller information och publicerar artiklar på
hemsidan "Fokus på anhöriga" samt medverkar vid nationella och regionala konferenser.

Kunskapsöversikten bygger på en litteraturgenomgång av internationella och nationella vetenskapliga studier inom området. Den kartlägger de olika typerna av stöd som finns tillgängliga för anhöriga till personer som får vård i livets slutskede och bor hemma. Kunskapsöversikten är viktig ur ett anhörigperspektiv då anhöriga i den typen av situationer är en grupp som ofta ställs inför stora utmaningar – att försöka förlika sig med den förestående förlusten av någon de älskar, samtidigt som de vill se att den sista tiden i livet ska blir så bra som möjligt.

Den 1 juli 2009 infördes en ny bestämmelse i 5 kap. 10 § socialtjänstlagen. Syftet
med lagändringen är att tydliggöra att socialnämnden ska erbjuda stöd för att
underlätta för de personer som vårdar och stödjer närstående. Vidare framhålls
att det ur ett förebyggande perspektiv är angeläget att kommunerna erbjuder olika
stödinsatser. Med stöd menas olika insatser som primärt syftar till att fysiskt,
psykiskt och socialt underlätta för person som vårdar eller stödjer närstående.
Kommunernas anhörigstöd har tidigare främst riktats till anhöriga till äldre
personer. Denna rapport belyser det befintliga stödet och utvecklingsbehoven för
anhöriga till närstående under 65 år i Nacka kommun. Kartläggningen grundar sig
på ett 40-tal intervjuer enskilt eller i grupp med handläggare och strategiska
personer inom kommunen samt hälso- och sjukvårdens verksamheter. Andra
som har intervjuats är anhöriga, gode män, personer vid överförmyndarenheten,
frivilligorganisationer, patient & anhörigorganisationer, kyrkans verksamheter
m.fl. Resultatet visar utifrån det befintliga stödet som erbjuds idag

Meddelandebladet innehåller information om att kommuner bör analysera och ha en aktiv strategi för sitt arbete med anhörigstöd. Detta är ett av flera meddelandeblad kopplade till bestämmelsen om att kommunen ska erbjuda anhörigstöd.

Sedan den 1 juli 2009 ska landets kommuner erbjuda stöd till anhöriga
som vårdar eller stödjer någon som är långvarigt sjuk, äldre eller har
funktionshinder. Karin Lindgren som arbetar på Socialstyrelsens enhet
för funktionshindersfrågor vill med denna artikel uppmärksamma anhö-
riga till yngre personer, en grupp som anhörigstödet i många kommuner
ännu inte har så stor erfarenhet av. Förhoppningsvis kan artikeln vara
till hjälp när det gäller att börja tänka på hur stöd anpassat till denna
målgrupp av anhöriga ska utformas

I den nya handboken om stöd till barn och unga med funktionsnedsättning får du som handläggare och personal svar på frågor om hur stödet kan utformas.

Hur gör du som LSS handläggare när det ser ut som att lag och verklighet inte går ihop? Vad får föräldrar respektive personalen bestämma och vad får den unge själv bestämma i ett boende? Vad har kommunen för ansvar för planering och uppföljning?

Viktigt att tänka förebyggande
I boken får du exempel på olika stöd som kan ges till barn och familjer. Här framhålls vikten av att tänka förebyggande och vilka risker det kan innebära när familjer inte får tillräckligt stöd. Du som handläggare får också information om vad en personkretsbedömning omfattar och hur barn kan bli delaktiga i handläggningsprocessen.

Stöd för att orka med sitt föräldraskap
– Även om inte LSS ska kompensera för bristande föräldraförmåga, kan LSS-insatserna verka förebyggande så att föräldrarna orkar med sitt föräldraskap. Föräldrarna till ett barn som till exempel behöver vändas flera gånger om natten kan både bli uttröttade och tappa tålamodet. Genom att bevilja avlösning på ett sätt som passar föräldrarna ökar förutsättningarna för att de ska orka med situationen och få utrymme även för syskon och egna intressen, säger projektledaren Ylva Branting.

Viktigt stöd i olika åldrar
Du som förestår eller jobbar på ett boende får exempel på vilka behov omvårdnaden är tänkt att tillgodose. Här görs en koppling till barnens utveckling och vad som är viktigt stöd i olika åldrar. I boendet ställs många frågor på sin spets, till exempel hur en bra bostad bör utformas fysiskt och vad av vårdnadshavarens ansvar som kan tas över av personal. Många av dessa frågor är också aktuella i samband med andra stödformer.

Grund i lagstiftning och forskning
Handboken bygger på lagstiftning, förarbeten, konventioner och rättsfall samt Socialstyrelsens föreskrifter och allmänna råd. Men vissa delar bygger också på källor från psykologisk och pedagogisk forskning.

I den nya handboken om stöd till barn och unga med funktionsnedsättning får du som handläggare och personal svar på frågor om hur stödet kan utformas.

Hur gör du som LSS handläggare när det ser ut som att lag och verklighet inte går ihop? Vad får föräldrar respektive personalen bestämma och vad får den unge själv bestämma i ett boende? Vad har kommunen för ansvar för planering och uppföljning?

Viktigt att tänka förebyggande
I boken får du exempel på olika stöd som kan ges till barn och familjer. Här framhålls vikten av att tänka förebyggande och vilka risker det kan innebära när familjer inte får tillräckligt stöd. Du som handläggare får också information om vad en personkretsbedömning omfattar och hur barn kan bli delaktiga i handläggningsprocessen.

Stöd för att orka med sitt föräldraskap
– Även om inte LSS ska kompensera för bristande föräldraförmåga, kan LSS-insatserna verka förebyggande så att föräldrarna orkar med sitt föräldraskap. Föräldrarna till ett barn som till exempel behöver vändas flera gånger om natten kan både bli uttröttade och tappa tålamodet. Genom att bevilja avlösning på ett sätt som passar föräldrarna ökar förutsättningarna för att de ska orka med situationen och få utrymme även för syskon och egna intressen, säger projektledaren Ylva Branting.

Viktigt stöd i olika åldrar
Du som förestår eller jobbar på ett boende får exempel på vilka behov omvårdnaden är tänkt att tillgodose. Här görs en koppling till barnens utveckling och vad som är viktigt stöd i olika åldrar. I boendet ställs många frågor på sin spets, till exempel hur en bra bostad bör utformas fysiskt och vad av vårdnadshavarens ansvar som kan tas över av personal. Många av dessa frågor är också aktuella i samband med andra stödformer.

Grund i lagstiftning och forskning
Handboken bygger på lagstiftning, förarbeten, konventioner och rättsfall samt Socialstyrelsens föreskrifter och allmänna råd. Men vissa delar bygger också på källor från psykologisk och pedagogisk forskning.

Barn som bevittnar våld mot en förälder som de är beroende av för sitt välbefinnande
utsätts för en form av våld. Barn behöver – i synnerhet under den tidiga barndomen –
föräldrar som prioriterar barnets behov framför sina egna. När barnets ena förälder –
eller någon annan som bor med familjen – slår eller förgriper sig på den andra föräldern
blir barnet känslomässigt övergivet och skyddslöst.
Barn kan bevittna våld mot en primär omsorgsgivare under kortare eller längre
perioder i sitt liv, men ofta innebär det ett liv begränsat av olika typer av makt,
övergrepp och förtryck. Sådana upplevelser medför en ökad risk för att barnet utvecklar
problem såsom posttraumatisk stress, depression, beteendeproblem och problem med
sociala relationer – både inom familjen och med kamrater.
Sedan 2007 är socialtjänstens ansvar, för att barn som bevittnat våld får det stöd och
den hjälp de behöver, förtydligat i Socialtjänstlagen.
Det viktigaste stödet för barn som bevittnat våld mot sin mamma är skydd från fortsatt
utsatthet. Internationellt sett är den vanligaste formen av stöd till barn, utöver sådant
skydd, samtal i grupp. Det finns dock stora skillnader mellan vilka mål programmen är
tänkta att uppnå, vilket medför att utvärderingsstudier använder varierande mått för att
bedöma vad som är ett "lyckat utfall". Detta försvårar i sin tur jämförelser av
utvärderingar av dessa program. I Sverige är den vanligaste typen av insats fortfarande
individuella samtal, även om gruppverksamheter för barn har blivit vanligare de senaste
10 åren. Kunskapen om effekterna av de metoder som utvecklats inom och utom
socialtjänsten för att stödja barn som bevittnat våld mot mamma är fortfarande
begränsad internationellt och i Sverige är den i stort sett obefintlig.
Göteborgs universitet fick 2008 i uppdrag av Socialstyrelsen att utvärdera effekten av
insatser riktade till barn som bevittnat våld mot sin mamma. Syftet med utvärderingen
var att studera förändringar i barns hälsa och välbefinnande efter stödinsatser, med
utgångspunkt i mammors och barns beskrivningar. Detta syfte preciseras i följande
frågeställningar:
1. Hur såg barnens familjesituation ut med avseende på vårdnad, boende och
umgänge och utsatthet för våld, samt barnens hälsa och välbefinnande när
insatsen påbörjades?
2. Förändrades barnens hälsa och välbefinnande från när insatsen påbörjades till
ett år senare som en konsekvens av insatsen, och skiljde sig förändringen åt
mellan olika typer av insatser?
3. Skiljde sig förändringarna åt gällande: barnens ålder och kön, våldsutsatthet eller
problembelastning, mammans socioekonomiska status, omfattningen av insatsen,
eller tiden för insatsen i barnens liv?
4. Hur stor andel av barnen hade problem på klinisk nivå gällande allmän psykisk
ohälsa och trauma före och efter de olika insatserna?
5. Hur nöjda var mammorna och barnen med de insatser de hade fått? Skiljde sig
deras nöjdhet mellan olika insatser?

Våren 2006 kartlades verksamheter i Sverige som arbetar för att få män som
utövar våld att upphöra med sin våldsutövning mot kvinnor och barn, samt
verksamheter som riktar sig till flickor och pojkar som i sin familj upplever
mäns våld mot kvinnor. Med anledning av en nationell utvärdering av
stödinsatser till barn, vilken pågår 2008 till 2011, genomfördes en förnyad
kartläggning sommaren 2010, av verksamheter riktade till barn som upplever
våld. För denna ansvarade docent Maria Eriksson, Sociologiska institutionen,
Uppsala universitet. Forskningsassistent Marta Wycichowska deltog
också i arbetet. Den här rapporten redovisar resultatet av den förnyade kartläggningen
och beskriver förändringar på fältet under perioden 2006 till
2010.
2010 års kartläggning har begränsats till de typer av organisationer som
utifrån 2006 års rapport kan antas vara de mest relevanta när det handlar om
stöd till barn som upplevt våld: kommunala verksamheter, kvinnojourer samt
barn- och ungdomspsykiatriska mottagningar. Kvinnojourerna respektive
barn- och ungdomspsykiatriska mottagningar fick en enkät som motsvarar
den som skickades ut 2006. Verksamheter i kommunal regi kartlades genom
en genomgång av kommunernas hemsidor. När det gäller vissa nytillkomna
verksamheter har informationen från hemsidan kompletterats med telefonintervjuer.
För att lokalisera verksamheter har viss information också inhämtats
via Länsstyrelserna, forsknings- och projektfinansiärer (som Allmänna
Arvsfonden) samt genom generella sökningar på internet och personliga
kontakter på fältet.
Kartläggningen visar att stöd till barn som upplevt våld är ett fält som
fortfarande expanderar. Antalet identifierade verksamheter har ökat och i
den länsvisa förteckning över verksamheter som finns i rapportens bilaga 1
återfinns totalt 132 verksamheter (jämfört med 87 år 2006). Det är framförallt
bland kommunerna ökningen kan ses och kartläggningen tyder på att det
idag är minst 147 av landets kommuner som själva erbjuder stöd till barn
som upplevt våld. Kartläggningen visar också att det här är ett fält som konsoliderats,
på så sätt att flera små aktörer (i första hand kommuner) slagit sig
samman och etablerat gemensamma verksamheter. Vidare är det fler verksamheter
erbjuder både individuella insatser och grupper för barn, 46 jämfört
med 26 år 2006. Det går att urskilja några nyheter på fältet, i form av nya
modeller för barngrupper, och för terapi för barn och deras omsorgspersoner.
Nyheterna till trots är dock de övergripande tendenserna i stöd och hjälp till
10
barn som upplevt våld densamma 2010 som de var 2006: den vanligaste
formen av insats riktad direkt till barnen tycks fortfarande vara individuella
samtal, oftast benämnda krissamtal, och det är fortfarande oklart i vilken
grad det finns specialisthjälp för de barn som behöver annan hjälp än individuella
krissamtal eller en pedagogisk barngrupp.
Det har varit möjligt att hitta uppgifter om individuella samtal för barn
från minst 112 verksamheter (jämfört med 67 år 2006). Även denna gång är
det så att det i de flesta fall finns uppgifter om att det här arbetet följer eller
inspirerats av Rädda Barnens arbetsmodell Trappan. Det gäller både kommuner
och frivilligorganisationer. När det gäller grupper för barn har de
också blivit vanligare, jämfört med läget 2006. Uppgifter om grupper för
barn finns från 61 verksamheter (jämfört med 41 år 2006). Fortfarande dominerar
modeller för pedagogiska och jag-stödjande grupper vilka ursprungligen
utarbetats för grupper för barn till föräldrar som missbrukar alkohol.
Det går dock att se en del nyheter på fältet. Internationellt har särskilda program
för barn som upplever mäns våld mot kvinnor har funnits sedan åtminstone
15 år tillbaka. Den stora skillnaden mellan dessa program och de
modeller som ligger till grund för de pedagogiska och jag-stödjande grupperna
i Sverige är att de internationella mycket tydligare sätter fokus på våld
och skydd. Ett av dessa våldsfokuserade program finns nu också översatt till
svenska: ett kanadensiskt grupprogram riktat till förskolebarn respektive
skolbarn. Till programmet hör också en insats till barnens mammor. Ytterligare
en ny våldsfokuserad modell för arbetet i barngrupper är en modell för
terapigrupper för barn hämtad från Alternativ til Vold i Oslo (ATV). Den är
utformad för barn i skolåldern eller äldre och även här är rekommendationen
att arbetet med barnen åtföljs med en parallell insats riktad till mammorna
och om möjligt även till papporna. Vid Alla Kvinnors Hus i Stockholm har
ytterligare en ny typ av grupp utvecklats, som ett komplement till befintliga
gruppinsatser. I ett projekt med medel från Allmänna Arvsfonden har boende
barn erbjudits dramagrupp. Den här typen av grupp har fokus på konsekvenserna
av våldet, snarare än känslomässig bearbetning och våldet "i sig".
Kartläggningen från 2006 visade att skyddade boenden för våldsutsatta
kvinnor och deras barn erbjuder ytterligare interventioner för barn som går
utöver individuella samtal och grupp. Det är både ett miljöterapeutiskt inriktat
arbete och stöd i vardagen så att barnen får en rimlig tillvaro under tiden
på det skyddade boendet. Redan 2006 stod det klart att de frivilliga kvinnojourerna
uppmärksammar barn i allt högre utsträckning. Enligt enkätsvaren
2010 kommer den ökande uppmärksamheten också till uttryck i att kvinnojourerna
satsar mer resurser på barn. Av enkäten framgår att 74 av de 97
svarande jourerna har anställd personal (jämfört med 57 av 70 svarande jourer
2006) och att av dessa har 31 (42 procent) personal med särskilt ansvar
för att arbeta med barn/unga som upplevt våld (jämfört med 6 jourer, 11
procent 2006).
11
När det gäller specialisthjälp till barn som upplevt våld visade 2006 års
enkät till barn- och ungdomspsykiatriska mottagningar att det varierade avsevärt
från mottagning till mottagning hur man inom barn- och ungdomspsykiatrin
ser på frågan om barn som lever med våld i sin familj. Därigenom
blir barns möjligheter att få kvalificerad hjälp från barn- och ungdomspsykiatrin
väldigt olika beroende på var i landet de bor. Man kunde också notera
att när det gäller barn- och ungdomspsykiatrins särskilda insatser för barn
som upplever mäns våld mot kvinnor framkom att de flesta använde sig av
Rädda Barnens material Trappan. Det är samma material och modell som
används av socialtjänsten och frivilligorganisationerna. Med tanke på att
barn som söker hjälp hos BUP många gånger är barn med behov som socialtjänsten
och frivilligorganisationerna inte anser sig ha kompetens att tillgodose,
var dessa svar något som i sin tur väckte frågan i vilken grad barn- och
ungdomspsykiatrin i landets olika delar reellt möter behoven av en specialkompetens
som går utöver den som finns hos socialtjänst och frivilligorganisationer.
Den bild som förmedlas i 2010 års enkätsvar ligger på många sätt
nära den tidigare enkätens resultat. Sammantaget kan även svaren från 2010
års enkät tolkas som att BUP endast i undantagsfall erbjuder en insats inriktad
på barn som upplever mäns våld mot kvinnor. Det finns dock några nyheter
i enkäten. En av dessa är behandlingsmodellen Traumafokuserad kognitiv
beteendeterapi (TF-CBT), och just när det gäller TF-CBT pågår också
ett utvecklingsarbete på området.
När det gäller de perspektiv som interventionsmodellerna bygger på dominerar
fortfarande ett utvecklingsperspektiv på barn, där barn blir objekt för
vuxnas ansvar, snarare än aktörer med rätt till delaktighet och medbestämmande,
liksom könsblinda perspektiv där individuell avvikelse står i fokus.
Nyheterna på området skulle på sikt kunna bidra till en breddning av perspektiven.
Det är dock ännu för tidigt att dra några säkra slutsatser om en
sådan utveckling.

Sedan drygt fyra år tillbaka finns en bestämmelse i 5 kap. 10 § socialtjänstlagen (2001:453), SoL, om att kommunerna ska erbjuda stöd till personer som vårdar och stödjer närstående. Stödet till anhöriga har under denna tid fått en tydligare struktur och integrerats i kommunernas planer och styrdokument. Utbudet av olika typer av stöd till anhöriga har ökat, och kommunerna har inrättat tjänster, förbättrat informationen om stödet och arbetar med att införa ett anhörigperspektiv i alla verksamheter. Detta är en generell bild av socialtjänstens sätt att tillämpa bestämmelsen i SoL. Inom äldreomsorgen bedömer kommunerna att de tillämpar bestämmelsen i stor utsträckning, men i funktionshindersverksamheten och individ- och familjeomsorgen anger två tredjedelar av kommunerna att de tillämpar bestämmelsen i liten utsträckning. Det finns vissa problem med att tillämpa bestämmelsen. Äldreomsorgen har svårt att hitta anhöriga att hjälpa och relativt många anhöriga tackar nej till hjälp. Det kan betyda att handläggarna inte utreder de anhörigas behov av stöd, men det kan också bero på brister i samarbetet mellan handläggarna, anhörigkonsulenten och verksamheterna när det gäller stöd till anhöriga. Funktionshindersverksamheten framhåller ofta att den fokuserar på brukaren i första hand. De flesta brukare får redan hjälp med stöd av LSS, lagen om stöd och service till vissa funktionshindrade (1993: 387), och därmed även deras anhöriga. Kommunerna har däremot svårt att nå hjälptagare som enbart har socialtjänstinsatser och deras anhöriga. På motsvarande sätt uppger individ- och familjeomsorgen att stödet till anhöriga är integrerat i klientarbetet och att bestämmelsen i SoL inte tillför det arbetet något. Den framhåller missbruksvården, där det finns ett stort utbud av stöd till makar, barn och andra familjemedlemmar. Individ- och familjeomsorgen beskriver däremot stora problem med att nå anhöriga till personer inom socialpsykiatrin. Får anhöriga stöd? I dag är det svårt att veta hur många anhöriga som får stöd eftersom detta bara är andra året som Socialstyrelsen samlar in uppgifter om serviceinsatser. Resultaten hittills pekar att olika former av anhörigstöd är en mycket omfattande verksamhet i kommunerna. Det saknas däremot underlag för att beskriva det stöd som ges till anhö-riga efter prövning enligt 4 kap. 1 § SoL. Med dagens dokumentation går det inte att ta fram dessa uppgifter i den officiella statistiken över social-tjänstens insatser. Det är därför angeläget att kunna beskriva biståndsprövade stödinsatser till anhöriga. Socialstyrelsen arbetar på uppdrag av regeringen med att utveckla socialtjänststatistiken och ta fram en plan för statistiken beträffande kommunernas anhörigstöd, hemsjukvård och insatser som inte är biståndsprövade. Hälso- och sjukvården och anhöriga Många anhöriga har långvarig kontakt med akutsjukvården, specialistsjukvården och inte minst primärvården, och därmed spelar sjukvården en viktig roll för både de sjuka och för deras anhöriga. Hittills har kommunerna dock inte lyckats etablera samarbete med hälso- och sjukvården i någon större utsträckning. Socialtjänstens kontakter och initiativ till samverkan leder sällan till ett systematiskt samarbete kring anhörigstödet. Det grundläggande problemet är att det saknas en struktur och rutiner för samarbetet mellan landstinget och socialtjänsten när det gäller stöd till anhöriga. I framtiden kommer dessutom hemsjukvården att vara ett kommunalt ansvar i hela landet, och därmed finns skäl till att utveckla hemsjukvårdens roll när det gäller stöd till anhöriga. Socialstyrelsens slutsatser Socialstyrelsen kan konstatera att lagstiftningen ännu inte har fått tillräckligt genomslag. Det krävs ytterligare arbete för att föra in ett anhörigperspektiv i socialtjänsten och i hälso- och sjukvården. Socialstyrelsens uppföljning visar att kommunerna behöver ytterligare vägledning i hur de ska tillämpa bestämmelsen i SoL. Kommunerna behöver fortsätta att utveckla formerna för bemötandet av anhöriga, utreda de anhörigas behov av stöd i de olika verksamheterna samt utveckla informationen om det stöd som finns att få och se till att den når fram. Hälso- och sjukvården behöver utveckla formerna för bemötande av anhöriga och att erbjuda dem stöd. Det är viktigt att hälso- och sjuk-vården och socialtjänsten samarbetar för den anhörigas och närstå-endes bästa. För att även inspirera hälso- och sjukvården i dess arbete med stöd till anhöriga kommer Socialstyrelsen att fortsätta att sammanställa exempel på hur sådant arbete har byggts upp runt om i landet. Socialstyrelsen kommer att stödja olika patient-, anhörig-, funktionshinders-, frivillig- och pensionärsorganisationers behov av information genom att ta fram en informationsskrift om bestämmelsen. Socialstyrelsen kommer under 2014 att genomföra olika informationsinsatser för att ge kommunerna ytterligare vägledning när det gäller att införa bestämmelsen om stöd till anhöriga.

Den 1 juli 2009 infördes en ny bestämmelse i 5 kap. 10 § socialtjänstlagen
(2001:453), SoL. Den anger att "socialnämnden ska erbjuda stöd för att underlätta
för de personer som vårdar en närstående som är långvarigt sjuk
eller äldre eller som stödjer en närstående som har funktionshinder". Bestämmelsen
har varit i kraft i två och ett halvt år. Den här rapporten sammanfattar
utvecklingen under 2010 och 2011. Med anhörig avses fortsättningsvis
den som ger vård och stöd och med närstående menas den som
mottar hjälpen.
Socialstyrelsen vägledningsarbete
I enlighet med regeringens förordning har Socialstyrelsen för år 2010 utbetalat
300 miljoner kronor till kommunerna för att underlätta tillämpningen
av den aktuella bestämmelsen.
Socialstyrelsens har under året haft en bred dialog med företrädare för socialtjänsten
för vägledning i arbetet med att utveckla stödet till anhöriga.
Socialstyrelsen har också anordnat seminarier med handläggare för att diskutera
deras roll i tillämpningen av 5 kap. 10 § SoL. Arbetet kommer att
dokumenteras i en vägledningsskrift, som syftar till att underlätta kommunens
arbete med att utveckla strategier och styrdokument för hela socialtjänsten,
som tydliggör vad som förväntas av personal och verksamheter,
när det gäller bemötande och stöd till anhöriga.
Likaså har Socialstyrelsen startat en dialog med patient-, anhörig-, handikapp-,
frivilligorganisationer för att få en bättre bild av deras roll när det
gäller tillämpningen av bestämmelsen. Arbetet har resulterat i en omarbetad
informationsbroschyr som ska gå ut till vård- och omsorgspersonal, organisationer
och allmänheten.
Kännedom om bestämmelsen
Inom socialtjänsten känner allt fler till bestämmelsen, vilket är en positiv
utveckling. Det är mycket svårare att veta i vad mån den är känd bland
kommuninvånarna och i vilken utsträckning informationen når fram till
"personer som vårdar eller stödjer närstående". Socialtjänstens handläggare
har en nyckelroll i att informera om 5 kap. 10 § SoL och dess innebörd.
Det är viktigt att organisationer som företräder anhöriga känner till och
informerar om bestämmelsen bland sina medlemmar. Det är dock inte givet
att anhörig-, patient-, handikapp- eller frivilligorganisationerna känner till
bestämmelsen. Organisationerna efterlyser här en dialog med kommunen.
Inom hälso- och sjukvården känner personalen inte till 5 kap. 10 § SoL i
tillräcklig utsträckning. Hälso- och sjukvårdspersonalens kunskap, eller brist
på kunskap, om bestämmelsen i socialtjänstlagen kan påverka sjukvårdens
intresse för att samverka med socialtjänsten i anhörigfrågor.
8
Tillämpningen av bestämmelsen
Inom äldreomsorgen har arbetet med bestämmelsen gått in i en konsolideringsfas;
man säkrar och förstärker det som uppnåtts i det tidigare arbetet.
Det är en positiv utveckling. Däremot vet Socialstyrelsen inte i vilken utsträckning
biståndshandläggarna inom äldreomsorgen har också beakta anhörigas
behov när de handlägger ärenden som rör den närstående.
Funktionshindersverksamheten har kommit igång med arbetet att utveckla
stödet till anhöriga. Många kommuner har genomfört kartläggningar av
verksamheten, för att få ett underlag för hur stödet till anhöriga ska utvecklas
vidare. På motsvarande sätt är det oklart i vad mån handläggarna har ett
anhörigstödjande förhållningssätt. Dessutom kan funktionshinderverksamhetens
starka brukarperspektiv göra det svårare att samtidigt ta till sig ett
anhörigperspektiv.
Individ- och familjeomsorgen befinner sig i startfasen när det gäller att
forma sitt anhörigstöd. Det betyder inte att man saknar insatser som de kan
erbjuda anhöriga. Individ- och familjeomsorgen ser ofta samarbetet med
anhöriga som en integrerad del i arbetet med brukarna. Utifrån detta måste
man utveckla sitt stöd till anhöriga.
För socialtjänsten som helhet är det fortfarande svårt att få till stånd ett
brett samarbete med hälso- och sjukvården när det gäller stöd till anhöriga.
Konsekvenserna av bestämmelsen
Förutom kommunernas redovisning av hur man arbetat med att tillämpa
socialtjänstlagens bestämmelse, har Socialstyrelsen små möjligheter att beskriva
konsekvenserna av bestämmelsen för enskilda anhöriga och om de
erbjudits och tagit emot stöd från socialtjänsten eller ej. Det skapar stora
svårigheter att få en bild av tillämpningen av bestämmelsen, liksom utvecklingen
av stödet till anhöriga som vårdar och stödjer närstående överhuvudtaget.
Socialstyrelsen saknar underlag för att redovisa hur vanligt det är att
enskilda får behovsprövade insatser, eller serviceinsatser till stöd.
Socialstyrelsens slutsatser och förslag
• Kommunerna behöver ta fram mål för stödet till anhöriga enligt 5 kap.
10 § SoL och tydliggöra vad som förväntas av socialtjänstens personal
beträffande bemötande och stöd till anhöriga. Det underlättar även samarbetet
med hälso- och sjukvården, med patient-, anhörig-, handikapp-,
frivilligorganisationer och med kommuninvånarna.
• Det finns behov av ett utvecklingsarbete inom socialtjänstens samtliga
verksamheter så att personalen kan omsätta ett anhörigperspektiv i sitt
arbete. Särskilt viktigt är att diskutera vilken delaktighet och därmed
vilket inflytande man erbjuder anhöriga.
• Socialtjänsten har ofta kontakt med anhöriga i samband med handläggningen
av den enskildes ansökan om hjälp. Här är det viktigt att man
samtidigt uppmärksammar också anhörigas behov av stöd.
9
• Många anhöriga har långvarig kontakt med landstingets hälso- och sjukvård.
Det är därför angeläget att utveckla samarbetet mellan landstinget
och kommunen beträffande stöd till anhöriga. Särskilt samverkan mellan
socialtjänsten och primärvården behöver utvecklas.
• Kommunerna har mycket att vinna på att förbättra dialogen med patient-
, anhörig-, handikapp- och frivilligorganisationerna, informera om den
aktuella bestämmelsen och om dess innebörd för organisationernas medlemmar.

• För att kunna vidareutveckla stödet till anhöriga inom socialtjänstens
olika verksamheter, är det viktigt att kunna följa resultatet av arbetet.
Kommunernas dokumentation och system för verksamhetsuppföljning
måste därför också innefatta 5 kap. 10 § SoL.
• Socialstyrelsen kommer att i sitt vägledningsarbete ha fokus på att stödja
utvecklingen inom funktionshindersverksamheten och individ- och familjeomsorgen.
Vägledningsarbetet kommer också att vidgas till att omfatta
hälso- och sjukvården i stödet till anhöriga. Socialstyrelsen kommer
samla in mängduppgifter av serviceinsatser till stöd för anhöriga, i
en kommunenkät 2012.

Kommunernas tillämpning av bestämmelsen
Sedan drygt fyra år tillbaka finns en bestämmelse i 5 kap. 10 § socialtjänstlagen
(2001:453), SoL, om att kommunerna ska erbjuda stöd till personer
som vårdar och stödjer närstående. Stödet till anhöriga har under denna tid
fått en tydligare struktur och integrerats i kommunernas planer och styrdokument.
Utbudet av olika typer av stöd till anhöriga har ökat, och kommunerna
har inrättat tjänster, förbättrat informationen om stödet och arbetar
med att införa ett anhörigperspektiv i alla verksamheter.
Detta är en generell bild av socialtjänstens sätt att tillämpa bestämmelsen
i SoL. Inom äldreomsorgen bedömer kommunerna att de tillämpar bestämmelsen
i stor utsträckning, men i funktionshindersverksamheten och individoch
familjeomsorgen anger två tredjedelar av kommunerna att de tillämpar
bestämmelsen i liten utsträckning.
Det finns vissa problem med att tillämpa bestämmelsen. Äldreomsorgen
har svårt att hitta anhöriga att hjälpa och relativt många anhöriga tackar nej
till hjälp. Det kan betyda att handläggarna inte utreder de anhörigas behov
av stöd, men det kan också bero på brister i samarbetet mellan handläggarna,
anhörigkonsulenten och verksamheterna när det gäller stöd till anhöriga.
Funktionshindersverksamheten framhåller ofta att den fokuserar på brukaren
i första hand. De flesta brukare får redan hjälp med stöd av LSS, lagen
om stöd och service till vissa funktionshindrade (1993: 387), och därmed
även deras anhöriga. Kommunerna har däremot svårt att nå hjälptagare som
enbart har socialtjänstinsatser och deras anhöriga.
På motsvarande sätt uppger individ- och familjeomsorgen att stödet till
anhöriga är integrerat i klientarbetet och att bestämmelsen i SoL inte tillför
det arbetet något. Den framhåller missbruksvården, där det finns ett stort
utbud av stöd till makar, barn och andra familjemedlemmar. Individ- och
familjeomsorgen beskriver däremot stora problem med att nå anhöriga till
personer inom socialpsykiatrin.
Får anhöriga stöd?
I dag är det svårt att veta hur många anhöriga som får stöd eftersom detta
bara är andra året som Socialstyrelsen samlar in uppgifter om serviceinsatser.
Resultaten hittills pekar att olika former av anhörigstöd är en mycket
omfattande verksamhet i kommunerna.
Det saknas däremot underlag för att beskriva det stöd som ges till anhö-
riga efter prövning enligt 4 kap. 1 § SoL. Med dagens dokumentation går
det inte att ta fram dessa uppgifter i den officiella statistiken över socialtjänstens
insatser.
Det är därför angeläget att kunna beskriva biståndsprövade stödinsatser till
anhöriga. Socialstyrelsen arbetar på uppdrag av regeringen med att utveckla
socialtjänststatistiken och ta fram en plan för statistiken beträffande kom-
7
munernas anhörigstöd, hemsjukvård och insatser som inte är biståndsprö-
vade.
Hälso- och sjukvården och anhöriga
Många anhöriga har långvarig kontakt med akutsjukvården, specialistsjukvården
och inte minst primärvården, och därmed spelar sjukvården en viktig
roll för både de sjuka och för deras anhöriga. Hittills har kommunerna dock
inte lyckats etablera samarbete med hälso- och sjukvården i någon större
utsträckning. Socialtjänstens kontakter och initiativ till samverkan leder
sällan till ett systematiskt samarbete kring anhörigstödet.
Det grundläggande problemet är att det saknas en struktur och rutiner för
samarbetet mellan landstinget och socialtjänsten när det gäller stöd till anhö-
riga. I framtiden kommer dessutom hemsjukvården att vara ett kommunalt
ansvar i hela landet, och därmed finns skäl till att utveckla hemsjukvårdens
roll när det gäller stöd till anhöriga.
Socialstyrelsens slutsatser
Socialstyrelsen kan konstatera att lagstiftningen ännu inte har fått tillräckligt
genomslag. Det krävs ytterligare arbete för att föra in ett anhörigperspektiv i
socialtjänsten och i hälso- och sjukvården. Socialstyrelsens uppföljning visar
att kommunerna behöver ytterligare vägledning i hur de ska tillämpa
bestämmelsen i SoL.
• Kommunerna behöver fortsätta att utveckla formerna för bemötandet
av anhöriga, utreda de anhörigas behov av stöd i de olika verksamheterna
samt utveckla informationen om det stöd som finns att få och
se till att den når fram.
• Hälso- och sjukvården behöver utveckla formerna för bemötande av
anhöriga och att erbjuda dem stöd. Det är viktigt att hälso- och sjukvården
och socialtjänsten samarbetar för den anhörigas och närstå-
endes bästa.
• För att även inspirera hälso- och sjukvården i dess arbete med stöd
till anhöriga kommer Socialstyrelsen att fortsätta att sammanställa
exempel på hur sådant arbete har byggts upp runt om i landet.
• Socialstyrelsen kommer att stödja olika patient-, anhörig-, funktionshinders-,
frivillig- och pensionärsorganisationers behov av information
genom att ta fram en informationsskrift om bestämmelsen.
• Socialstyrelsen kommer under 2014 att genomföra olika informationsinsatser
för att ge kommunerna ytterligare vägledning när det
gäller att införa bestämmelsen om stöd till anhöriga.

Kommunernas tillämpning av bestämmelsen

Den 1 juli 2009 infördes en bestämmelse i 5 kap. 10 § socialtjänstlagen (2001:453), SoL, om att socialtjänsten ska erbjuda stöd till personer som vårdar eller stödjer närstående.

Socialstyrelsens uppföljning visar att socialtjänstverksamheterna i kommunerna tillämpar bestämmelsen i mycket varierande grad. Längst har man kommit inom äldreomsorgen, vilket förklaras av utvecklingen av anhörigstöd i huvudsak skedde inom äldreomsorgen, innan bestämmelsen tillkom. Inom funktionshindersverksamheten och individ- och familjeomsorgen har man kommit igång, men mycket arbete återstår för att omsätta bestämmelsen utifrån de specifika förutsättningar som finns i dessa verksamheter.

Kommunerna har dock överlag blivit bättre på att sätta upp mål, avsätta resurser och organisera arbetet med att stödja anhöriga. Likaså har de ökat sitt utbud av service som stöd till anhöriga. Det betyder sammantaget att kommunerna erbjuder stöd till anhöriga i högre grad än tidigare.

Vad har bestämmelsen inneburit för de anhöriga?

Det är svårt att följa upp och beskriva bestämmelsens effekter för enskilda anhöriga eftersom det saknas underlag för att avgöra om fler anhöriga erbjudits och tagit emot stöd eller inte. Det beror på att uppgifterna om biståndsbeviljade insatser i socialtjänststatistiken inte innefattar uppgifter om bistånd till anhöriga.

Vad anser organisationerna om bestämmelsen?

Överlag är anhörig-, patient-, funktionshinders-, frivillig- och pensionärsorganisationerna kritiska till bristen på stöd, de stora skillnaderna i kvalitet och de stora variationerna mellan kommunerna. Socialtjänsten har också svårt att erbjuda ett individuellt utformat stöd. Vidare kräver de att den personal som arbetar med att stödja anhöriga ska ha kunskaper om de sjukdomar eller funktionsnedsättningar som de närstående har.

Organisationerna framhåller att det stöd som deras medlemmar behöver inte kan tillgodoses enbart inom socialtjänsten, utan det krävs stöd från sjukvården, skolan, arbetsgivaren och myndigheter, t.ex. försäkringskassan. Organisationerna poängterar också problemen med att samordna insatser för den närstående, och att det oftast är de anhöriga som tvingas ta det ansvaret.

Socialtjänstens samarbete med hälso- och sjukvården

Socialtjänsten har ett mycket begränsat samarbete med sjukvården när det gäller stödet till anhöriga, och socialtjänstens företrädare pekar på att det saknas en motsvarande lagstiftning om stöd till anhöriga i sjukvården. Det är också svårt att organisera ett kommunvis samarbete med sjukhus- och specialistvården som ofta betjänar många kommuner samtidigt. Även samarbetet med primärvården fungerar dåligt. Det grundläggande problemet är dock att det saknas en etablerad struktur för samarbetet mellan landstinget och socialtjänsten på området.

Har bestämmelsen fått några andra konsekvenser?

Sedan bestämmelsen infördes bedrivs allt mer av vården och omsorgen i hemmet, som en följd av att det finns färre sjukhusplatser och platser i särskilt boende. Detta får stora konsekvenser för de anhöriga.

I och med bestämmelsen har det blivit tydligt att lagen gäller för hela socialtjänsten och alla dess målgrupper och verksamheter. Bestämmelsen berör alla som vårdar eller stödjer någon närstående, oberoende av den närståendes diagnos, funktionsnedsättning, ålder, kön, relation, boendeförhållanden osv.

Det har också vuxit fram en insikt om att alla påverkas om det finns en hjälpbehövande person i familjen: oavsett om det är en make, ett barn eller en vuxen, en förälder eller ett syskon. Det gäller också oavsett i vilken utsträckning den anhöriga ger vård och omsorg till den sjuke.

En annan erfarenhet är att behovet av att uppmärksamma de anhörigas situation och behov av stöd inte enbart är en fråga för socialtjänsten utan för hela samhället: sjukvården, skolan, arbetslivet, myndigheterna och så vidare. Det pekar på behovet av ett förändrat synsätt, från ett individcentrerat till ett familjeorienterat synsätt i vården och omsorgen.

Socialstyrelsens slutsatser

Socialstyrelsen konstaterar att det återstår en del arbete för att bestämmelsen ska tillämpas mer i socialtjänsten och för att få ett anhöriginkluderande arbetssätt i all vård- och omsorgsverksamhet.

Kommunerna behöver bli bättre på att informera om vilket stöd de kan erbjuda, och hur anhöriga kan gå tillväga för att ansöka om det eller på annat sätt få stöd.
Kommunerna behöver utveckla dialogen med anhörig-, patient-, funk
tionshinders-, frivillig- och pensionärsorganisationerna för att ta vara på de kunskaper och erfarenheter som organisationerna har när det gäller stöd till anhöriga som vårdar närstående.
Huvudmännen behöver utveckla former och rutiner för samarbete kring stödet till anhöriga. Ett sätt kan vara länsövergripande överenskommelser om samverkan mellan sjukvården och socialtjänsten.
Socialtjänstens olika verksamheter, särskilt funktionshindersverksamheten och individ- och familjeomsorgen, behöver fortsatt stöd för att utveckla sin tillämpning av bestämmelsen. Ett fortsatt stöd bör också ta sikte på att utveckla möjligheterna att följa upp utvecklingen av stödet till anhöriga och att stimulera utvecklingen av kunskaper om effekter av stöd till anhöriga.

Kommunernas tillämpning av bestämmelsen

Den 1 juli 2009 infördes en bestämmelse i 5 kap. 10 § socialtjänstlagen (2001:453), SoL, om att socialtjänsten ska erbjuda stöd till personer som vårdar eller stödjer närstående.

Socialstyrelsens uppföljning visar att socialtjänstverksamheterna i kommunerna tillämpar bestämmelsen i mycket varierande grad. Längst har man kommit inom äldreomsorgen, vilket förklaras av utvecklingen av anhörigstöd i huvudsak skedde inom äldreomsorgen, innan bestämmelsen tillkom. Inom funktionshindersverksamheten och individ- och familjeomsorgen har man kommit igång, men mycket arbete återstår för att omsätta bestämmelsen utifrån de specifika förutsättningar som finns i dessa verksamheter.

Kommunerna har dock överlag blivit bättre på att sätta upp mål, avsätta resurser och organisera arbetet med att stödja anhöriga. Likaså har de ökat sitt utbud av service som stöd till anhöriga. Det betyder sammantaget att kommunerna erbjuder stöd till anhöriga i högre grad än tidigare.

Vad har bestämmelsen inneburit för de anhöriga?

Det är svårt att följa upp och beskriva bestämmelsens effekter för enskilda anhöriga eftersom det saknas underlag för att avgöra om fler anhöriga erbjudits och tagit emot stöd eller inte. Det beror på att uppgifterna om biståndsbeviljade insatser i socialtjänststatistiken inte innefattar uppgifter om bistånd till anhöriga.

Vad anser organisationerna om bestämmelsen?

Överlag är anhörig-, patient-, funktionshinders-, frivillig- och pensionärsorganisationerna kritiska till bristen på stöd, de stora skillnaderna i kvalitet och de stora variationerna mellan kommunerna. Socialtjänsten har också svårt att erbjuda ett individuellt utformat stöd. Vidare kräver de att den personal som arbetar med att stödja anhöriga ska ha kunskaper om de sjukdomar eller funktionsnedsättningar som de närstående har.

Organisationerna framhåller att det stöd som deras medlemmar behöver inte kan tillgodoses enbart inom socialtjänsten, utan det krävs stöd från sjukvården, skolan, arbetsgivaren och myndigheter, t.ex. försäkringskassan. Organisationerna poängterar också problemen med att samordna insatser för den närstående, och att det oftast är de anhöriga som tvingas ta det ansvaret.

Socialtjänstens samarbete med hälso- och sjukvården

Socialtjänsten har ett mycket begränsat samarbete med sjukvården när det gäller stödet till anhöriga, och socialtjänstens företrädare pekar på att det saknas en motsvarande lagstiftning om stöd till anhöriga i sjukvården. Det är också svårt att organisera ett kommunvis samarbete med sjukhus- och specialistvården som ofta betjänar många kommuner samtidigt. Även samarbetet med primärvården fungerar dåligt. Det grundläggande problemet är dock att det saknas en etablerad struktur för samarbetet mellan landstinget och socialtjänsten på området.

Har bestämmelsen fått några andra konsekvenser?

Sedan bestämmelsen infördes bedrivs allt mer av vården och omsorgen i hemmet, som en följd av att det finns färre sjukhusplatser och platser i särskilt boende. Detta får stora konsekvenser för de anhöriga.

I och med bestämmelsen har det blivit tydligt att lagen gäller för hela socialtjänsten och alla dess målgrupper och verksamheter. Bestämmelsen berör alla som vårdar eller stödjer någon närstående, oberoende av den närståendes diagnos, funktionsnedsättning, ålder, kön, relation, boendeförhållanden osv.

Det har också vuxit fram en insikt om att alla påverkas om det finns en hjälpbehövande person i familjen: oavsett om det är en make, ett barn eller en vuxen, en förälder eller ett syskon. Det gäller också oavsett i vilken utsträckning den anhöriga ger vård och omsorg till den sjuke.

En annan erfarenhet är att behovet av att uppmärksamma de anhörigas situation och behov av stöd inte enbart är en fråga för socialtjänsten utan för hela samhället: sjukvården, skolan, arbetslivet, myndigheterna och så vidare. Det pekar på behovet av ett förändrat synsätt, från ett individcentrerat till ett familjeorienterat synsätt i vården och omsorgen.

Socialstyrelsens slutsatser

Socialstyrelsen konstaterar att det återstår en del arbete för att bestämmelsen ska tillämpas mer i socialtjänsten och för att få ett anhöriginkluderande arbetssätt i all vård- och omsorgsverksamhet.

Kommunerna behöver bli bättre på att informera om vilket stöd de kan erbjuda, och hur anhöriga kan gå tillväga för att ansöka om det eller på annat sätt få stöd.
Kommunerna behöver utveckla dialogen med anhörig-, patient-, funk
tionshinders-, frivillig- och pensionärsorganisationerna för att ta vara på de kunskaper och erfarenheter som organisationerna har när det gäller stöd till anhöriga som vårdar närstående.
Huvudmännen behöver utveckla former och rutiner för samarbete kring stödet till anhöriga. Ett sätt kan vara länsövergripande överenskommelser om samverkan mellan sjukvården och socialtjänsten.
Socialtjänstens olika verksamheter, särskilt funktionshindersverksamheten och individ- och familjeomsorgen, behöver fortsatt stöd för att utveckla sin tillämpning av bestämmelsen. Ett fortsatt stöd bör också ta sikte på att utveckla möjligheterna att följa upp utvecklingen av stödet till anhöriga och att stimulera utvecklingen av kunskaper om effekter av stöd till anhöriga.

Sedan den 1 juli 2009 ska socialnämnden enligt socialtjänstlagen erbjuda stöd till personer som vårdar eller stödjer en anhörig. Genom enkäter till socialtjänstens verksamheter och kontakter på alla nivåer samt med anhörig-, patient- och frivilligorganisationer har följande bild av hur kommunerna tillämpar bestämmelsen framkommit.

Bristen på dokumentation gör det svårt att få en bild av hur den nya bestämmelsen tillämpas, omfattningen av det stöd som ges och hur stödet utvecklas. Utvecklingen av stödet till anhöriga till personer med långvarig sjukdom eller personer med funktionshinder har kommunerna inte prioriterat tillräckligt högt. Därför är det på dessa områden som Socialstyrelsen kommer att inrikta sitt vägledningsarbete.

Äldreprägeln består

Fortfarande finns en tydlig äldreprägel i arbetet med att erbjuda stöd till anhöriga, eftersom kommunerna i första hand ger stöd till anhöriga till äldre. Arbetet, organisationen, utbudet och innehållet i kommunernas stöd till anhöriga har sina rötter inom vården och omsorgen om de äldre.

Arbetet med att stödja anhöriga är inte integrerat i alla socialtjänstens verksamheter. Stödet håller på att utvecklas, men mycket arbete återstår med att ge stöd till anhöriga till personer med långvarig sjukdom eller yngre personer med funktionshinder.

Kulturskillnader i synen på anhöriga

Man kan tala om olika kulturer i synen på och sättet att förhålla sig till anhöriga i socialtjänsten. De olika verksamheterna har olika och ibland vitt skilda uppdrag och historia. De möter anhöriga i skilda livssituationer och med olika levnadsförhållanden och därmed olika behov av stöd och hjälp.

Anhörigstöd i individ- och familjeomsorgen innebär till exempel ofta något annat än stöd för anhöriga till äldre. På samma sätt har anhöriga till personer med långvarig sjukdom eller funktionshinder ofta andra livsvillkor än anhöriga till äldre, och därmed andra behov av stöd och hjälp.

Brist på data

Det är svårt att få en bild av hur den nya bestämmelsen tillämpas, och av hur stödet till anhöriga som vårdar eller stödjer närstående utvecklas. Problemet är att socialtjänstens behovsprövade insatser dokumenteras på ett sådant sätt att man inte kan identifiera om insatsen beviljas som ett stöd till den anhöriga eller inte. Det är otillfredsställande att Socialstyrelsen inte kan beskriva hur den nya bestämmelsen påverkar enskilda anhöriga. En stor del av socialtjänstens insatser för anhöriga utgörs av icke behovsprövade insatser, s.k. allmänt inriktad service. Det saknas dock för närvarande underlag för att kunna beskriva omfattningen av de serviceinsatser som ges som stöd till anhöriga.

Slutsatser

Socialstyrelsen anser att kommunerna inte har prioriterat att utveckla stöd för anhöriga till långvarigt sjuka och personer med funktionshinder tillräckligt högt.
Socialtjänstens verksamheter behöver fortsätta utveckla arbetet om hur man bemöter anhöriga och se över vilken delaktighet och därmed vilket inflytande de erbjuder anhöriga, särskilt när de handlägger den närståendes ansökan om hjälp.
Många anhöriga har en långvarig kontakt med både hälso- och sjukvården och socialtjänsten. Därför är det nödvändigt att huvudmännen utvecklar kontakterna och rutinerna för samarbete i stödet till anhöriga.
Socialstyrelsen konstaterar att stödet till anhöriga till äldre är mest utvecklat. Socialstyrelsen kommer därför att inrikta sitt vägledningsarbete på utvecklingen av stödet till anhöriga till personer med långvarig sjukdom eller personer med funktionshinder.
Socialstyrelsen kommer att utveckla dialogen med patient-, anhörig- och frivilligorganisationer, för att ta vara på organisationernas kunskaper och erfarenheter i arbetet med att utveckla stödet till anhöriga.
Socialstyrelsen konstaterar att det saknas underlag för att beskriva omfattningen av stödet till anhöriga. Socialstyrelsen avser därför att påbörja arbetet med att skapa ett system, för att kunna samla in uppgifter om serviceinsatser till stöd för anhöriga.

I propositionen föreslås en ändring i socialtjänstlagen (2001:453) som syftar till att förtydliga att socialnämnden ska erbjuda stöd för att under-lätta för de personer som vårdar en närstående som är långvarigt sjuk eller äldre eller som stödjer en person som har funktionshinder.
Vidare bedöms att Socialstyrelsen bör få i uppdrag att utarbeta vägled-ning till stöd för tillämpningen av lagstiftningen som rör socialtjänstens arbete med stöd till de personer som vårdar eller stödjer närstående.
Ändringen i socialtjänstlagen föreslås träda i kraft den 1 juli 2009.

I landets kommuner har sedan slutet av 1990-talet ett omfattande arbete utförts för att
utveckla stödet till anhöriga. För att dra lärdom utvecklingsarbetet har Nationellt
kompetenscentrum anhöriga (Nka) tagit initiativ till denna undersökning för att i samverkan
med åtta av landets FoU-enheter kartlägga och följa utvecklingen av stödet till anhöriga under
tre år i åtta kommuner.
Syftet med studien är att:
- Kartlägga innehållet i stödet till anhöriga, hur stödet organiseras, planeras, följs upp
och utvärderas inom områdena äldre, funktionshinder och individ- familjeomsorg samt
samverkan mellan kommun, landsting, ideella organisationer och andra aktörer inom
området.
- Undersöka hur de olika huvudintressenterna bedömer kvaliteten på stödet till anhöriga
- Under tre år följa utvecklingen i de kommuner/kommundelar som ingår i studien.
Stödet till anhöriga i de utvalda kommunerna har kartlagts år 2010 och år 2013 genom att ta
del av tillgängliga dokument, kommunernas hemsida och informationsblad samt intervjuer
med och enkätutskick till chefer och andra nyckelpersoner. Genom en enkätstudie med
uppföljande telefonintervjuer har anhörigas situation och syn på sitt stöd, undersökts vid två
tillfällen. Årligen genomfördes fokusgruppsintervjuer, en inom vardera äldre-,
funktionshinder- samt individ och familjeområdet med syftet att beskriva och följa
utvecklingen av stödet till anhöriga; vad som fungerade bra och mindre bra. I varje
fokusgrupp ingick personal, beslutsfattare och representanter från ideella sektorn.
I denna delrapport, som också är slutrapport för hela projektet, presenteras resultatet för den
sista kartläggningen, gällande år 2013. Utvecklingen av anhörigstödet under de senaste åren
beskrivs också genom en jämförelse av resultaten från de olika kartläggningarna.
Tyngdpunkten i denna sammanfattning ligger på denna jämförelse.
Resultat
Det har inte skett några omvälvande förändringar i anhörigstödet i Uppsala kommun som
helhet under åren 2010 till 2013, men utvecklingen har inte stått stilla. Medvetenheten om
vikten av ett anhörigperspektiv hade på flera håll ökat.
Anhörigcentrum genomgick under tidsperioden en stor organisationsförändring.
Verksamheten bedrevs under två år som projekt, för att sedan fortsätta med ettåriga avtal i
väntan på beslut om eventuell konkurrensutsättning. Kunskapen om Anhörigcentrums
existens ökade under undersökningsperioden i kommunen och allt fler anhöriga sökte sig dit.
Målgruppen förändrades genom att också inkludera anhöriga till personer på boenden.
Anhöriga till äldre personer var fortfarande den största målgruppen, men en ökning av
anhöriga till yngre personer och framför allt från psykiatri och socialpsykiatri kunde noteras.
Utformningen av stödet till anhöriga var i stort densamma, men förändrades i viss mån till
exempel genom att anhöriggrupperna vände sig till andra målgrupper, rekreationshelger
infördes och anhöriga fick möjlighet till juristhjälp. Behovsinventeringar gjordes årligen, men
på lite olika sätt och med olika fokus. Anhörigcentrum ingick vid tiden för kartläggning två i
kommunens Nöjd-Kund-Index. Samverkan med landstinget utvecklades under tidsperioden
med t.ex. bemanning av "anhörighörna" på Akademiska sjukhuset och Anhörigcentrum hade
också tagit en aktiv del i landstingets projekt för utveckling av anhörigstöd.
8
I Äldrenämndens uppdragsplaner var effektmålen desamma för anhörigstödet under
uppföljningstiden, men målvärdena för antalet personer som skulle använda sig av
anhörigstödet (läs Anhörigcentrum) ökade från år till år. I förfrågningsunderlaget gällande
hemvård hade nya ska-krav införts under en egen rubrik; Anhörigvänlig vård och omsorg.
Inom hemvården hade också anhöriga börjat uppmärksammas genom anhörigträffar
information med mera. Inom vård- och omsorgsboendena fortsatte anhörigstödet
huvudsakligen inom den palliativa och avancerade sjukvården, men nytt var att Silviasystrar
inom åtminstone ett annat boende hade introducerat anhöriggrupper. Ett omfattande
värdegrundsarbete genomfördes inom äldreomsorgen som också inkluderade anhörigfrågor.
I förfrågningsunderlagen för upphandling av LSS-boendeenheter hade år 2013 infogats, under
rubriken Anhöriga, specifika ska-krav rörande anhöriga som inte hade funnits tidigare. Inom
Affärsområde assistans hade en grupp chefer i utvecklingssyfte börjat arbeta med
anhörigfrågor och anhörigas delaktighet. Verksamheten för anställda anhöriga bedrevs med
höga ambitioner och engagemang. Affärsområdeschefen i Affärsområde barn, ungdom &
familj beklagade bristen på stöd till anhöriga till personer under 21 år. Några insatser inom
verksamheten hade blivit mer flexibla bland annat för att underlätta för anhöriga. Arbete med
Samordnad individuell plan (Sip) infördes under uppföljningstiden och detta trodde många
skulle underlätta anhörigas situation.
I måldokument från de båda åren lyftes helhetsperspektiv och familjens roll fram på likartat
sätt inom individ- och familjeområdet. I kommunens drogpolitiska program nämndes
anhöriga som målgrupp för verksamheten. Viktiga stödinsatser erbjöds under hela den
undersökta tidsperioden inom Råd- och behandlingsgruppen, Trappan och familjeenheterna.
Inom Affärsområde socialpsykiatri & beroende hade en ny form av utbildning skapats. Den så
kallade återhämtningsakademin som ämnade samla brukare, personal och anhöriga i
gemensamma utbildningar.
Resultaten från enkäten till de anhöriga skiljer sig inte i någon större omfattning mellan de
båda studerade åren. Det är relativt stora andelar av respondenterna som beskriver en
problematisk livssituation och resultaten antyder också att det är de känslomässiga
dimensionerna som kan kräva ytterligare stödinsatser.
Det mest slående resultatet i de båda intervjuundersökningarna var att de anhöriga var nöjda
med det stöd som de hade fått. Framför allt gällde detta Anhörigcentrums verksamhet.
Rapporten avslutas med en begreppsdiskussion. Orden anhöriga, närstående, anhörigstöd med
flera används på olikartade sätt. För att kunna beskriva, följa, jämföra och inte minst utveckla
innehållet i stödet till anhöriga krävs att begreppsapparaten utvecklas. Fördelar och nackdelar
med ett specialiserat centraliserat anhörigstöd i jämförelse med ett integrerat decentraliserat
stöd diskuteras vidare och vikten av att ett anhörigperspektiv och anhörigstöd implementeras i
hela socialtjänsten betonas. För detta krävs bland annat att anhörigfrågorna finns med i
styrdokumenten på alla nivåer och att utbildningsinsatser genomförs.
Uppsala kommun har i en nationell jämförelse legat långt framme i anhörigfrågor under en
lång tid. Klimatet för att bygga upp och utveckla ett (specialiserat) anhörigstöd har varit gott.
En förhoppning är att den positiva trenden kommer att fortsätta i vetskapen om att mycket
hitintills är gjort, men att de svåraste uppgifterna kanske återstår; att se till att
anhörigperspektiv och anhörigstöd integreras inom hela socialtjänsten.

Riksrevisionen har granskat om staten har gett förutsättningar för ett stöd till anhöriga
omsorgsgivare som motsvarar behoven.
Granskningens bakgrund
Någon gång i livet kommer de flesta av oss att ge omsorg eller hjälp till någon i vår
närhet som drabbas av sjukdom, en funktionsnedsättning eller som får behov av hjälp
på grund av hög ålder. Vi blir då anhöriga omsorgsgivare. Det kan vara så många som
1,3 miljoner anhöriga i Sverige som ger omsorg till en närstående. De flesta anhöriga
ger omsorg av fri vilja och har en god hälsa. Undersökningar visar dock att anhörigas
hälsa, ekonomi, arbetssituation och möjligheter till fritid kan påverkas negativt av
omsorgsgivandet. Ofta bor dessa anhöriga tillsammans med den de ger omsorg till, en
make/maka/partner, ett barn eller ett syskon, och deras omsorg är omfattande.
Att som anhörig ge vård och omsorg ska vara ett frivilligt åtagande och ett komplement
till det offentligas insatser. I praktiken är dock det offentligas insatser ett komplement till
de anhörigas omsorgsgivande enligt regeringen. Ett gott stöd till anhöriga är viktigt för
att undvika negativa konsekvenser av omsorgsgivandet för individer och för samhället.
Syftet har varit att granska om staten har gett förutsättningar för ett stöd till anhöriga
omsorgsgivare som motsvarar behoven. Staten har främst valt att tillgodose anhörigas
behov av stöd genom att ändra socialtjänstlagen, 1998 och 2009, i syfte att förtydliga
kommunernas ansvar för stöd till anhöriga. Efter lagändringen 2009 ska kommunerna
erbjuda stöd till anhöriga. I regeringens propositioner inför lagändringarna har det
framgått att stödet ska kännetecknas av individualisering, flexibilitet och kvalitet.
Granskningen bygger främst på intervjuer med anhöriga, anhörig- och
patientorganisationer, forskare och företrädare för myndigheter och Nationellt
kompetenscentrum anhöriga (Nka). Intervjuerna har kompletterats med
forskningsresultat och kvantitativa studier.

Granskningens resultat
Riksrevisionens övergripande slutsats är att staten inte har gett goda förutsättningar för
ett stöd till anhöriga omsorgsgivare som motsvarar behoven. Granskningen visar att
anhörigas behov av stöd ofta handlar om att den närstående får en god vård och omsorg
men också om ett individanpassat och flexibelt stöd till dem själva.
Kommunernas anhörigstöd behöver utvecklas
En av de möjligheter till individualiserat stöd som regeringen betonade år 2009 var
att anhöriga skulle ansöka om bistånd för egen del. Under granskningen har det
framkommit att det är ovanligt och att omfattningen är svår att följa upp på grund
av bristande dokumentation. Riksrevisionens granskning tyder också på att brister i
kvalitet och flexibilitet i anhörigstöd leder till att anhöriga väljer att inte utnyttja det stöd
som erbjuds.
Det är stora skillnader i vilket stöd som erbjuds anhöriga och hur anhörigstödet styrs
inom och mellan kommuner enligt Socialstyrelsens kartläggningar. Stödet är i de
flesta kommuner mest utbyggt inom äldreomsorgen med utgångspunkt i situationer
där äldre makar ger omsorg till varandra. Det innebär enligt Riksrevisionen att äldre
makar i större utsträckning erbjuds stöd som motsvarar behoven än exempelvis
förvärvsarbetande anhöriga, anhöriga till funktionshindrade eller personer med
psykisk ohälsa. Sedan år 2009 har kommunerna börjat utforma stöd utifrån andra
anhöriggruppers behov i högre utsträckning än tidigare.
Kommunerna har även organiserat, styrt och finansierat anhörigstödet olika. I de
flesta kommunerna har dock anhörigstödet främst bedrivits i projektform, vid sidan
av ordinarie linjeorganisation. Det är också ovanligt att det finns styrdokument som
innehåller rutiner med ett anhörigperspektiv.
Riksrevisionen anser att kommunernas anhörigstöd behöver utvecklas för att uppfylla
intentionerna om ett individualiserat, flexibelt och kvalitativt stöd. Enligt Riksrevisionen
har utbudet av stöd hittills inte varit tillräckligt anpassat till anhörigas skiftande behov
och skillnaderna indikerar att kommunerna i olika utsträckning har valt att prioritera
stöd till anhöriga.
Staten bör ge bättre förutsättningar för det kommunala anhörigstödet
Kommunerna har fått ett stort utrymme att själva avgöra vilket anhörigstöd som de ska
erbjuda eftersom kommunernas ansvar har reglerats med en ramlagsbestämmelse i
socialtjänstlagen. I förarbetena preciserade regeringen att stödet bör kännetecknas av
individualisering, flexibilitet och kvalitet. Eftersom kommunerna har valt att främst
erbjuda anhörigstöd som kommunal service finns det begränsade möjligheter för
domstolarna att tydliggöra vilket stöd kommunerna ska erbjuda genom vägledande
rättsfall.

riksrevisionen granskar: medborgarna och förvaltningen
Regeringen har gett Socialstyrelsen i uppdrag att vägleda kommunerna i
implementeringen av bestämmelsen och inrättat ett nationellt kompetenscentrum
för att förbättra kunskapsläget. Trots dessa åtgärder nås ännu inte intentionerna
med det kommunala anhörigstödet och det skiljer sig åt vilket stöd anhöriga erbjuds
inom och mellan kommuner. Riksrevisionen menar därför att ytterligare vägledning
till kommunerna troligtvis inte är tillräckligt för att åstadkomma anhörigstöd som
motsvarar intentionerna.
Riksrevisionen anser att staten inte har gett tillräckligt goda förutsättningar för ett
kommunalt anhörigstöd som motsvarar intentionerna. Riksrevisionen rekommenderar
därför regeringen att överväga om 5 kap. 10 § socialtjänstlagen behöver förtydligas.
Statens styrmedel kan användas bättre
Sedan år 1999 har staten totalt satsat cirka 2 miljarder kronor på att utveckla
anhörigstöd i kommunerna. Riksrevisionens granskning visar att det delvis är oklart
vilka resultat som uppnåtts med de statliga satsningarna på kommunalt anhörigstöd.
Ett hinder för kunskap om satsningarna är att det saknas nationell statistik över vilket
stöd kommunerna erbjuder anhöriga och som anhöriga tar del av, vilket förklaras av
brister i dokumentation av anhörigstödet.
Varken Socialstyrelsen eller Inspektionen för vård och omsorg har hittills
genomfört någon riktad tillsyn av kommunernas skyldighet att erbjuda anhöriga
stöd. Riksrevisionen bedömer att tillsyn med nuvarande förutsättningar inte är ett
ändamålsenligt styrmedel för att komma tillrätta med problemen i kommunernas
anhörigstöd.
Riksrevisionen rekommenderar att om regeringen vill möjliggöra uppföljning, ökad
kunskap samt tillsyn av anhörigstödet i kommunerna bör regeringen ta ställning
till hur anhörigstödet som ges som service och bistånd ska dokumenteras av
kommunerna.
Det behövs mer kunskap om anhörigomsorgen
Idag finns det inga jämförbara studier om anhörigomsorgens utveckling över tid. De
undersökningar som finns har genomförts av olika aktörer och med olika frågor och
urval. Därmed är resultaten svåra att jämföra. Det saknas också kartläggningar av
omfattningen på minderåriga barns omsorgsgivande till närstående. Sammantaget
medför detta att det även saknas underlag för att bedöma de samhällsekonomiska
konsekvenserna av och kostnaderna för anhörigomsorgen på individ- och samhällsnivå.

stödet till anhöriga omsorgsgivare
Riksrevisionen rekommenderar att regeringen ger en myndighet i uppdrag att följa
anhörigomsorgens omfattning och konsekvenserna för individer och samhället över
tid. Ett steg bör vara att ta fram en samhällsekonomisk analys av anhörigomsorgens
konsekvenser för individer och samhälle. Jämställdhetsaspekterna bör särskilt
uppmärksammas i en sådan analys.
Det bör vara lättare att förena anhörigomsorg med arbete
Anhöriga som arbetar och som ger omsorg är i stor utsträckning beroende av sina
arbetsgivares välvilja för att kunna stanna kvar på arbetsmarknaden. Detta då de
förmåner som finns – närståendepenning och rätten till ledighet vid närståendevård
och av trängande familjeskäl – bara täcker delar av anhörigas behov och används i liten
utsträckning. Anhöriga som arbetar är i många fall beroende av att själva kunna styra
sina arbetstider och att ta ledigt med kort varsel. Flera anhöriga tar också ut semester
och flextid för att kunna ge omsorg till sina närstående.
Riksrevisionen rekommenderar att regeringen överväger om delar av
socialförsäkringssystemet och arbetsmarknadslagstiftningen bör anpassas till anhörigas
behov för att underlätta för anhöriga att förena anhörigomsorg med arbete.
Det bästa anhörigstödet är en god vård och omsorg
Riksrevisionen anser att kvalitetshöjande åtgärder inom vård och omsorg är det som
i störst utsträckning skulle förbättra för anhöriga. I intervjuer har det framkommit
att det bästa stödet till anhöriga är en god vård och omsorg om den närstående. Det
handlar om omsorgsinsatser som exempelvis särskilda boenden och hemtjänst,
vårdinsatser som behandling och vårdplatser på sjukhus men också personal med rätt
utbildning och kompetens. Riksrevisionen har inte granskat vården och omsorgen om
den närstående i sig men har valt att redovisa hur viktig vården och omsorgen om den
närstående är för anhörigas situation och behov av stöd.
Det ska vara frivilligt att ge anhörigomsorg i Sverige. Riksrevisionen anser att en
förutsättning för frivillighet är att det finns ett alternativ till anhörigas insatser i form av
en god offentlig vård och omsorg. Riksrevisonens bedömning utifrån intervjuer under
granskningen är att många anhöriga tar på sig ett större ansvar än de egentligen vill på
grund av brister i vården och omsorgen.
Många anhöriga upplever att en av de tyngsta bördorna de har att bära är den
samordnande och koordinerande roll de ofta måste ta på sig. Om anhöriga inte tog på
sig koordinatorrollen skulle mycket falla mellan stolarna. Riksrevisionen menar att
detta är ett svårlöst problem som är kopplat till uppdraget till och organiseringen av
vården och omsorgen.
riksrevisionen granskar: medborgarna och förvaltningen

I Riksrevisionens intervjuer framkommer att anhörigas behov av att bli sedda och
få information och kunskap sällan tillgodoses i kontakter med vård och omsorg.
Vidare framförs i intervjuerna att vårdplaneringar är en situation där många anhöriga
känner sig osynliga. Riksrevisionen rekommenderar att regeringen bör se till att det tas
fram utbildningar för att sprida kunskap till anställda i kommuner och landsting om
anhörigas betydelse för vård och omsorg samt hur vården och omsorgen kan stödja
anhöriga genom bland annat information och bemötande.
De anhöriga som Riksrevisionen har intervjuat upplever att de måste kämpa för att få
de insatser som den närstående behöver från kommunerna och att de befinner sig i ett
kunskapsunderläge i förhållande till kommunerna om vilka insatser den närstående
har rätt till. Anhöriga beskriver också att det är svårt, tidskrävande och påfrestande
att överklaga beslut. Riksrevisionen rekommenderar regeringen att ge Socialstyrelsen i
uppdrag att informera om rätten till stöd och insatser i SoL och LSS och hur praxis ser
ut om regeringen vill underlätta för anhöriga.
Landstingen saknar ett strukturerat arbete med att ge stöd till vuxna anhöriga enligt
Nationellt kompetenscentrum anhöriga, Anhörigas Riksförbund och Socialstyrelsen.
I hälso- och sjukvårdslagen finns endast ett generellt folkhälsoförebyggande uppdrag
och ett uppdrag om att ge stöd till minderåriga barn i vissa situationer. Riksrevisionen
rekommenderar regeringen att överväga om landstingens ansvar för stöd till anhöriga
behöver förtydligas i hälso- och sjukvårdslagen.

BACKGROUND:
The impacts of maternal substance use have been observed in both research and clinical experience. Several studies have shown that preschool children are at heightened risk of developing various cognitive, behavioral, and socioemotional difficulties. Most knowledge has been generated concerning alcohol consumption during pregnancy and the postnatal effects thereof. Less is known about substance use other than alcohol (for instance, opiates, marijuana, and cocaine) during pregnancy and the long-term developmental consequences.
OBJECTIVE:
The aims of this review are to identify relevant published data on adolescents who have been exposed in utero to alcohol and/or other substances and to examine developmental consequences across functions and mental health at this point in life.
METHODS:
PubMed, Embase, and PsychInfo were searched for publications during the period of 1980-2011 and titles and abstracts selected according to prespecified broad criteria.
RESULTS:
Twenty-five studies fulfilled all of the specific requirements and were included in this review. Most research covered prenatal alcohol exposure. Other substances, however, included cocaine, marijuana, opiates, and poly-substances. Results showed that prenatal exposure to alcohol has long-term cognitive, behavioral, social, and emotional developmental consequences depending on amount and timing of exposure in utero. Less evidence exists for long-term consequences of exposure in utero to other substances than alcohol. However, recent brain-imaging studies have provided important evidence of serious effects of other substance exposure on the developing brain and recent follow-up studies have found an association with deficits in language, attention, areas of cognitive performance and delinquent behavior in adolescence.

The expansion of the criminal justice system over the last several decades helped to focus attention on children of incarcerated parents, many of whom have parents with substance abuse problems. Since the 1990's, a national grassroots campaign has been underway to make substance abuse treatment an alternative to incarceration for parents who commit non-violent crimes. The question of interest in this article is what evidence there is, if any, that treating parental substance abuse changes children's outcomes. To answer this question, a systematic search was conducted for evidence that parental substance abuse treatment either (1) prevents children from developing serious problems (e.g., substance abuse, emotional/behavioral problems, and delinquency) or (2) ameliorates problems if children have already developed them. The key finding is that existing research is limited to studies primarily of the birth outcomes of children born to pregnant and perinatal substance-abusing mothers. Little is known about how treating parents' substance abuse problems affects the outcomes of older children or children of substance-abusing fathers.

BACKGROUND:
Few large sample studies have examined psychiatric morbidity among former child welfare/protection clients. In this study, risks for suicide attempts and severe psychiatric morbidity in younger years were assessed for former child welfare clients in ten national birth cohorts, comparing them with general population peers and inter-country adoptees.
METHODS:
We used national register data for almost one million people: 22,305 former child welfare clients who had experienced interventions before their teens, 955,326 general population cohort peers and 12,240 inter-country adoptees. Multivariate Cox regression models were used to estimate risks of hospitalisation for suicide attempts and psychiatric disorders from age 13 to age 18-27.
RESULTS:
Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts. They were five to eight times more likely to have been hospitalised for serious psychiatric disorders in their teens, four to six times in young adulthood. High excess risks were also found for psychoses and depression. Individuals who had been in long-term foster care tended to have the most dismal outcome. Adjusting for birth parents' hospitalisations with a psychiatric diagnosis or for substance abuse, and for birth-home-related socio-economic factors, reduced excess risks to around twofold.
CONCLUSIONS:
Irrespective of issues of causality, findings suggest that former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity. Results have substantial practice implications for mental health and social agencies serving this group in adolescence and/or young adulthood.

Abstract
BACKGROUND:
Few large sample studies have examined psychiatric morbidity among former child welfare/protection clients. In this study, risks for suicide attempts and severe psychiatric morbidity in younger years were assessed for former child welfare clients in ten national birth cohorts, comparing them with general population peers and inter-country adoptees.
METHODS:
We used national register data for almost one million people: 22,305 former child welfare clients who had experienced interventions before their teens, 955,326 general population cohort peers and 12,240 inter-country adoptees. Multivariate Cox regression models were used to estimate risks of hospitalisation for suicide attempts and psychiatric disorders from age 13 to age 18-27.
RESULTS:
Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts. They were five to eight times more likely to have been hospitalised for serious psychiatric disorders in their teens, four to six times in young adulthood. High excess risks were also found for psychoses and depression. Individuals who had been in long-term foster care tended to have the most dismal outcome. Adjusting for birth parents' hospitalisations with a psychiatric diagnosis or for substance abuse, and for birth-home-related socio-economic factors, reduced excess risks to around twofold.
CONCLUSIONS:
Irrespective of issues of causality, findings suggest that former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity. Results have substantial practice implications for mental health and social agencies serving this group in adolescence and/or young adulthood.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.

The present article describes two studies designed to identify some of the rules that may govern interactions with bereaved persons and whether those rules are different for suicidal deaths, as compared with death by accident or natural causes. In the first study, with university students, 28 rules were identified. The pattern of results suggests that the rules for suicide are more constraining; that is, judgments about the existence of social rules tend to be more inclusive and extreme, in a "should not do" direction, when the death is suicidal. In the second study, with adult citizens, 13 possible rules were examined. The pattern of results confirmed the findings obtained in the first study — that interacting with the survivors of a suicidal death was seen as a more constraining situation with a predominance of proscriptive rules. It was suggested that while individuals may feel greater compassion for the survivors of suicide, they may avoid the situation for fear of violating one of the proscriptive rules.

Dependency Drug Courts (DDCs) are a growing method of addressing the functional status and reunification success of families involved in child welfare and affected by substance use disorders. Despite widespread interest in DDCs, few evaluations have appeared in the literature to help inform the discussion about their effectiveness. This article provides a description of various types of DDCs and reports 24-month reunification rates from the Sacramento DDC. Results indicated that DDC participants had higher rates of treatment participation than did comparison participants. In addition, at 24 months, 42% of the DDC children had reunified versus 27.2% of the comparison children. There were no differences in treatment completion or child reunification rates by parent's primary drug problem. Rates of recidivism were extremely low for both the DDC and comparison groups and did not differ significantly. The results of the present study are encouraging and suggest that rigorous, controlled studies are merited to further evaluate the effectiveness of DDCs.

This study describes the Swedish debate on the role of family and state in care of elderly persons. It provides empirical evidence on the shifting balance of family, state, and market in the total panorama of elderly care. Secondary analysis of older (1954) and more recent data sources (1994 and 2000) is used to assess living arrangements and care patterns for persons 75 years or older living in the community. Results revealed that total spending on aged adults has stagnated, and institutional care is shrinking in absolute and relative terms, but public Home Help for elders in the community is decreasing even more. Family members increasingly shoulder the bulk of care, but privately purchased care also seems to expand. This study calculates how public and informal care changed between 1994 and 2000: Informal care is estimated to have provided 60% of all care to elders in the community in 1994 and 70% in 2000. The results parallel a crisis of legitimacy of public elderly care in Sweden. They also call into question various metaphors used to describe patterns of care. (PsycINFO Database Record (c) 2007 APA )

Abstract

PURPOSE:
This study describes the Swedish debate on the role of family and state in care of elderly persons. It provides empirical evidence on the shifting balance of family, state, and market in the total panorama of elderly care.
DESIGN AND METHODS:
Secondary analysis of older (1954) and more recent data sources (1994 and 2000) is used to assess living arrangements and care patterns for persons 75 years or older living in the community.
RESULTS:
Total spending on aged adults has stagnated, and institutional care is shrinking in absolute and relative terms, but public Home Help for elders in the community is decreasing even more. Family members increasingly shoulder the bulk of care, but privately purchased care also seems to expand. This study calculates how public and informal care changed between 1994 and 2000: Informal care is estimated to have provided 60% of all care to elders in the community in 1994 and 70% in 2000.

This meta-analytic review examines the association between attachment and internalizing symptomatology during childhood, and compares the strength of this association with that for externalizing symptomatology. Based on 42 independent samples (N = 4,614), the association between insecurity and internalizing symptoms was small, yet significant (d = 0.15, CI 0.06~0.25) and not moderated by assessment age of internalizing problems. Avoidance, but not resistance (d = 0.03, CI -0.11~0.17) or disorganization (d = 0.08, CI -0.06~0.22), was significantly associated with internalizing symptoms (d = 0.17, CI 0.03~0.31). Insecurity and disorganization were more strongly associated with externalizing than internalizing symptoms. Discussion focuses on the significance of attachment for the development of internalizing versus externalizing symptomatology.

This study addresses the extent to which insecure and disorganized attachments increase risk for externalizing problems using meta-analysis. From 69 samples (N = 5,947), the association between insecurity and externalizing problems was significant, d = 0.31 (95% CI: 0.23, 0.40). Larger effects were found for boys (d = 0.35), clinical samples (d = 0.49), and from observation-based outcome assessments (d = 0.58). Larger effects were found for attachment assessments other than the Strange Situation. Overall, disorganized children appeared at elevated risk (d = 0.34, 95% CI: 0.18, 0.50), with weaker effects for avoidance (d = 0.12, 95% CI: 0.03, 0.21) and resistance (d = 0.11, 95% CI: -0.04, 0.26). The results are discussed in terms of the potential significance of attachment for mental health.

How can the 'social capital' inherent in social networks provide contacts through which older people access practical and emotional support? What is the relative importance of kin and non-kin, and of participation in organisations and informal ties such as contacts with neighbours? Following a brief contextualisation that draws on previous literature, this paper addresses these questions through analysis of British Household Panel Survey (BHPS) data. It examines the extent to which people feel they can count on emotional and practical support from friends and relatives. A dependent variable was created that measures the outcome of the 'social capital' residing in a respondent's social network. Relatively poor support was found amongst elders who were childless or had been continuously without a partner; relatively rich support was found amongst those who had frequent contact with other people, who interacted frequently with neighbours, and who regarded their neighbourhood as a positive social environment. Being active in organisations had less effect on social support than informal social contacts. Amongst many different forms of organisational activity, the only ones that had a positive association with social support were being in contact with others through religious activities, and engaging in sports clubs. The social support of working-class elders, even those 'well networked' in formal or informal ways, was strengthened less by their social capital than was that of the professional and managerial occupational groups.

For decades, scholars have wrestled with the notion that old age is characterized by social isolation. However, there has been no systematic, nationally representative evaluation of this possibility in terms of social network connectedness. In this paper, the authors develop a profile of older adults' social integration with respect to nine dimensions of connectedness to interpersonal networks and voluntary associations. The authors use new data from the National Social Life, Health, and Aging Project (NSHAP), a population-based study of non-institutionalized older Americans aged 57-85 conducted in 2005-2006. Findings suggest that among older adults, age is negatively related to network size, closeness to network members, and number of non-primary-group ties. On the other hand, age is positively related to frequency of socializing with neighbors, religious participation, and volunteering. In addition, it has a U-shaped relationship with volume of contact with network members. These findings are inconsistent with the notion that old age has a universal negative influence on social connectedness. Instead, life course factors have divergent consequences for different forms of social connectedness. Some later life transitions, like retirement and bereavement, may prompt greater connectedness. The authors close by urging increased dialogue between social gerontological and social network research

PURPOSE:
There is a lack of comprehensive cost-of-illness studies in bipolar disorder, in particular studies based on patient-level data. The purpose of this study was to estimate the societal cost of bipolar disorder and to relate costs to disease severity, depressive episodes, hospitalisation and patient functioning.
METHODS:
Retrospective resource use data in inpatient and outpatient care during 2006-2008, as well as ICD-10 diagnoses and Global Assessment of Functioning (GAF) scores, were obtained from the Northern Stockholm psychiatric clinic with a catchment area including 47% of the adult inhabitants in Stockholm. This dataset was combined with national register data on prescription pharmaceuticals and sick leave to estimate the societal cost of bipolar disorder. The study was conducted from a societal perspective, with indirect costs valued according to the human capital method.
RESULTS:
The average annual cost per patient was 28,011 in 2008 (n = 1,846). Indirect costs due to sick leave and early retirement represented 75%, inpatient costs 13%, outpatient costs 8%, pharmaceuticals 2% and community care another 2% of the total cost. Total costs were considerably higher during mood episodes (six times higher than in remission), for hospitalised patients (55,500 vs. 22,200) and for patients with low GAF scores.
CONCLUSIONS:
The high cost of bipolar disorder is driven primarily by indirect costs. Costs were strongly associated with mood episodes, hospitalisations and low GAF scores. This suggests that treatment that reduces the risk for relapses and hospitalizations and improve functioning may decrease both the societal cost of bipolar disorder and patient suffering.

The Strengthening Washington DC Families Project (SWFP) examined implementation fidelity and effectiveness when a selective, evidence-based prevention program was implemented with a sample of 715 predominantly African American families across multiple settings in an urban area. Using a true experimental design, this study reports on the differential effectiveness of four conditions (child skills training only, parent skills training only, parent and child skills training plus family skills training, and minimal treatment controls) in reducing child antisocial behavior and its precursors. Major challenges with recruitment and retention of participants and uneven program coverage were documented. No statistically significant positive effects for any of the program conditions were observed, and a statistically significant negative effect on child reports of Negative Peer Associations was observed for children of families assigned to the family skills training condition. Two marginally significant findings were observed: Child's positive adjustment favored families assigned to family skills training condition relative to minimal treatment and child training only, and family supervision and bonding was lower for children in family skills training than in the other three conditions. Hypotheses about potential explanations for the weaker than expected effects of this program are offered, as are thoughts about the infrastructure necessary to successfully implement family strengthening programs and the future of prevention science.

This paper presents some of the key findings and recommendations of the report The Tasmanian Children's Project (TCP): The Needs of Children with a Parent/Carer with a Mental Illness, October, 1999. The TCP, a collaborative venture between the University of Tasmania's School of Nursing and the Mental Health Services - South, Tasmania (Department of Health and Human Services), is the first study in Tasmania to formally examine the needs of children where the parent/carer has a mental illness. The study is a modified replication and extension of the 1993/94 Victorian Children's Project. Extension aspects of the TCP included interviews with children (in addition to parents and service providers), the inclusion of data on both maternal and paternal mental illness and a broad definition of mental illness (beyond psychotic illness and major affective disorder). The report highlights the need to provide a range of programs that encourage the development of personal competency among children, parents, and other family members and those that emphasize interagency collaboration. Implications of this research for mental health nursing education and practice are also addressed.

The psychometric properties of the Timeline Followback Spousal Violence interview (TLFB-SV), a calendar method used to assess daily patterns and frequency of spousal violence, were evaluated. Men (N = 104) entering a spousal violence treatment program, along with their female partners, were interviewed with the TLFB-SV at pretreatment, posttreatment, and quarterly thereafter for 1 year and asked to identify days of male-to-female and female-to-male physical aggression that had occurred between them. For posttreatment and follow-up interviews, participants maintained a weekly diary, in which they catalogued the days on which acts of spousal violence occurred. The subscale scores derived from the TLFB-SV, the proportion of days of any violence, and proportion of days of severe violence for each partner were calculated for each assessment interval. The TLFB-SV subscales had excellent temporal stability and concurrent and discriminant validity. Interpartner agreement on TLFB-SV subscale scores and agreement between partners on days when spousal violence occurred was low at pretreatment, but was high for the other assessment periods.

Each level provides development possibilities within itself, and even if a level is reached that can't be expanded upon for an individual, the concepts used will allow for a fun and enriching learning experience, using Eye Control, at any level.

Until now, eye control and gaze interaction within assistive technology have been reserved for those who have a proven understanding of cause and effect and who are demonstrating that they are ready for an Alternative and Augmentative Communication (AAC) device that they will be able to use with their eyes and eye control, usually together with one or another type and level of AAC vocabulary.

Reaching the level of success with eye control and the level of cognitive ability needed to achieve a successful assessment – and thus, in many cases, the professional recommendation needed to purchase, fund and use an eye controlled device – can be difficult, if not sometimes impossible.

But at Tobii Dynavox, we believe that eye control, gaze interaction and their different methods for use are skills like any other. We believe that they should be taught in constructive and structured ways in order to assist individuals in learning the practical and cognitive skills needed to reach the level of ability required to communicate with AAC vocabularies using eye controlled devices, and even to open individuals up into the world of literate, long distance communication.

The Tobii Dynavox Eye Gaze Learning Curve is a step stone, leveled, component based, teaching-and-learning pathway for eye control and gaze interaction. It incorporates teaching and learning techniques, software and suggestions for care givers, teachers and professionals assisting users from their earliest experiences and engagements with a screen to those who are fully literate and need eye controlled computer access and long distance communication.

This study explores the transmission of trauma in 30 Middle Eastern refugee families in Denmark, where one or both parents were referred for treatment of PTSD symptoms and had non-traumatized children aged 4-9 years. The aim of the study was to explore potential risk and protective factors by examining the association between intra-family communication style regarding the parents' traumatic experiences from the past, children's psychosocial adjustment and attachment security. A negative impact of parental trauma on children might be indicated, as children's Total Difficulties Scores on the Strengths and Difficulties Questionnaire (SDQ) were significantly higher than the Danish norms. A negative association between children's attachment security as measured by the Attachment and Traumatization Story Task and higher scores on the SDQ Total Difficulties Scale approached significance, suggesting that the transmission of trauma may be associated with disruptions in children's attachment representations. Furthermore a significant association between parental trauma communication and children's attachment style was found.

This study explores the transmission of trauma in 30 Middle Eastern refugee families in Denmark, where one or both parents were referred for treatment of PTSD symptoms and had non-traumatized children aged 4-9 years. The aim of the study was to explore potential risk and protective factors by examining the association between intra-family communication style regarding the parents' traumatic experiences from the past, children's psychosocial adjustment and attachment security. A negative impact of parental trauma on children might be indicated, as children's Total Difficulties Scores on the Strengths and Difficulties Questionnaire (SDQ) were significantly higher than the Danish norms. A negative association between children's attachment security as measured by the Attachment and Traumatization Story Task and higher scores on the SDQ Total Difficulties Scale approached significance, suggesting that the transmission of trauma may be associated with disruptions in children's attachment representations. Furthermore a significant association between parental trauma communication and children's attachment style was found.

This study explores the transmission of trauma in 30 Middle Eastern refugee families in Denmark, where one or both parents were referred for treatment of PTSD symptoms and had non-traumatized children aged 4-9 years. The aim of the study was to explore potential risk and protective factors by examining the association between intra-family communication style regarding the parents' traumatic experiences from the past, children's psychosocial adjustment and attachment security. A negative impact of parental trauma on children might be indicated, as children's Total Difficulties Scores on the Strengths and Difficulties Questionnaire (SDQ) were significantly higher than the Danish norms. A negative association between children's attachment security as measured by the Attachment and Traumatization Story Task and higher scores on the SDQ Total Difficulties Scale approached significance, suggesting that the transmission of trauma may be associated with disruptions in children's attachment representations. Furthermore a significant association between parental trauma communication and children's attachment style was found.

This is a study about fairly ordinary situations in elder care: how staff deal with older people's influence, how staff talk about older people's complaints, how family members talk about elder mistreatment, and how older people act in order to exert influence in a nursing home. However ordinary, these are situations where relational power is accentuated, accomplished and able to be empirically explored. The aim here is to analyze power and influence as social phenomena in elder care. More specifically, the aims are 1) to analyze the political and bureaucratic frame in which older people have formal "voice" options; 2) to analyze staff members' "folk logic" as they respond to residents' complaints in Swedish nursing homes; 3) to analyze how family members of care recipients define and sustain claims of elder mistreatment; and 4) to ethnographically depict how older people's attempts at influence unfold in everyday interactions in a nursing home and how these attempts can be understood in the context of a "local routine culture."

Several kinds of empirical material have been used: 100 structured telephone interviews with local municipal officials, 13 qualitative interviews with nursing home staff, 21 interviews with family members of care recipients, and ethnographic data comprised of field notes and field-based interviews from five months of observation in a nursing home.

The findings demonstrate the difficulties of turning policies about older people's influence into practice. Yet, the main finding is not the "policy–practice gap" per se, but rather an understanding of how this gap is situationally shaped and maintained. The dissertation shows how the subtleties of actions and talk have powerful implications, and can constitute barriers to older people's influence. Two examples are the "rhetoric of trivialization" and a "local routine culture"; both can easily and quite inconspicuously restrict older people's autonomy and influence. A routine culture is a locally and situationally generated action repertoire and as such provides an understanding of how routines shape power relations in a nursing home. The findings also show how a rhetoric of trivialization can function as a power resource, through which older people's and family members' views are "made trivial" by the ways they are described and rhetorically treated by staff and local officials. Through the use of trivializing accounts, staff members legitimized their neglect of complaints and restrictions of older people's influence. The study argues that by recognizing how older people's influence is "made trivial," we gain an understanding of how to accomplish just the opposite. Local routines and accountability practices have a strong inertia, but the findings indicate that if actors reframe influence and complaints, they may substantially affect power relations in elder care.

This is a study about fairly ordinary situations in elder care: how staff deal with older people's influence, how staff talk about older people's complaints, how family members talk about elder mistreatment, and how older people act in order to exert influence in a nursing home. However ordinary, these are situations where relational power is accentuated, accomplished and able to be empirically explored. The aim here is to analyze power and influence as social phenomena in elder care. More specifically, the aims are 1) to analyze the political and bureaucratic frame in which older people have formal "voice" options; 2) to analyze staff members' "folk logic" as they respond to residents' complaints in Swedish nursing homes; 3) to analyze how family members of care recipients define and sustain claims of elder mistreatment; and 4) to ethnographically depict how older people's attempts at influence unfold in everyday interactions in a nursing home and how these attempts can be understood in the context of a "local routine culture."

Several kinds of empirical material have been used: 100 structured telephone interviews with local municipal officials, 13 qualitative interviews with nursing home staff, 21 interviews with family members of care recipients, and ethnographic data comprised of field notes and field-based interviews from five months of observation in a nursing home.

The findings demonstrate the difficulties of turning policies about older people's influence into practice. Yet, the main finding is not the "policy–practice gap" per se, but rather an understanding of how this gap is situationally shaped and maintained. The dissertation shows how the subtleties of actions and talk have powerful implications, and can constitute barriers to older people's influence. Two examples are the "rhetoric of trivialization" and a "local routine culture"; both can easily and quite inconspicuously restrict older people's autonomy and influence. A routine culture is a locally and situationally generated action repertoire and as such provides an understanding of how routines shape power relations in a nursing home. The findings also show how a rhetoric of trivialization can function as a power resource, through which older people's and family members' views are "made trivial" by the ways they are described and rhetorically treated by staff and local officials. Through the use of trivializing accounts, staff members legitimized their neglect of complaints and restrictions of older people's influence. The study argues that by recognizing how older people's influence is "made trivial," we gain an understanding of how to accomplish just the opposite. Local routines and accountability practices have a strong inertia, but the findings indicate that if actors reframe influence and complaints, they may substantially affect power relations in elder care.

Abstract:
This study examined Swedish suicide bereaved individuals' use of different resources in their grief work and how they value these resources. The material consisted of a web-based survey, which was analyzed with quantitative methods. The results showed that the psychosocial ill-health was severe among the suicide bereaved participants and that a majority used digital resources in their grief work. The propensity to engage in online support groups or memorial websites was not predicted by the severity of psychosocial consequences following the suicide. However, multiple regressions showed that higher online support group activity predicted more satisfaction with current psychosocial health, while memorial websites seemed to have the opposite effect. This study not only indicates that some digital resources, for example, online support groups, may be an effective way of coping with grief related to suicide loss, but also suggests that memorial websites may increase rumination and in this way cause emotional distress

The population's wish to receive care in the own home instead of at a hospital fits well with the Health Services' development in the direction of increasing home healthcare even when severe illness is involved. However, when care is moved from the hospital to the home the demands for high quality care still remain. Information and telecommunication technologies used in applications which are tailored to support caregivers and patients in home healthcare, can be part of the facilitation of this development towards an increasing home healthcare service. Remote monitoring of the patient in the home can support assuring this quality of care but such monitoring involves considering several requirement areas.This thesis describes problem areas in both basic and advanced home healthcare where information technology can be a part of the solution. Further, the thesis describes requirement areas to be considered when monitoring patients in the home, both in regard to subjective and objective variables. The requirement areas, which are described in the thesis, include security, mobility, and responsibility. Network solutions for home healthcare are discussed and two information technology applications in home healthcare are described. The first application concerns diabetes care and the second application concerns the use of digital pen technology for symptom assessments in advanced palliative home healthcare.

Although multisensory environments (MSE) are popular in schools educating students with severe disabilities, little is known about how teachers are using them. This paper reports on interviews with five teachers from two special schools who agreed to be videorecorded while using the room with their classes and who were interviewed about their perspectives on MSEs and about the activities observed in their classes. Most teachers seemed to believe that use of the MSE or the equipment in it would have automatic and remarkably wide ranging benefits for their students. There was more limited evidence of focused programing, teaching and monitoring practices that would result in functional outcomes for students. Given lack of empirical support for educational outcomes from MSE use, the authors call for more research on use of MSEs and for education authorities, schools, and teachers to more actively monitor and evaluate the effects of their use.

Innovative solutions for dementia care are required to address the steady rise in adults living with dementia, lack of adequate staffing to provide high-quality dementia care, and the need for family caregivers to provide care for their loved ones in the home. This article provides an overview of the use of socially assistive robots (SARs) to offer support as therapists, companions, and educators for people living with dementia. Social, ethical, and legal challenges associated with the use of robotic technology in patient care and implications for the use of SARs by nurses are discussed. These items considered, the authors conclude that SARs should be considered as a viable way to assist people living with dementia to maintain their highest possible level of independence, enhance their quality of life, and provide support to overburdened family caregivers. Further research is needed to evaluate the merits of this technological approach in the care of adults with dementia.

Policy guidelines insist that people with dementia should be involved in decisions about key life choices and transitions. However, as dementia affects both cognitive and communication difficulties, it becomes increasingly difficult to do this, and innovative and effective ways to support people with dementia and their carers to interact with each other are needed. This project, funded by Joseph Rowntree Foundation, examined if Talking Mats, a low-tech communication framework, could support family carers and people with dementia to discuss issues around daily living with each other. The fieldwork phase took place from September 2008 to May 2009. Eighteen couples (person with dementia and their family carer) from Scotland and the North of England were involved. The couples were visited in their own homes and asked to discuss together four topics (Personal Care; Getting Around; Housework; Activities) under two different conditions: (i) using the Talking Mats framework and (ii) using their usual communication methods (UCMs). After the interviews, each participant was asked separately to complete a short questionnaire (Involvement Measure), which included five questions to evaluate how involved s/he felt in each type of discussion and a final question to measure satisfaction with the overall discussion. The findings show that both people with dementia and their carers feel more involved in discussions about how they are managing their daily living when using the Talking Mats framework, compared with their UCM. They also feel more satisfied with the outcome of those discussions. The use of Talking Mats could result in increased well-being and positive adjustment to accepting increasing levels of care for people with dementia. In addition, it could improve the relationship between the person with dementia and family carers, if all involved feel that the views of the person with dementia and the family carer have truly been acknowledged. Adapted from the source document.

The EDE is a semistructured interview which has been developed as a measure of the specific psychopathology of anorexia nervosa and bulimia nervosa. To establish its discriminant validity it was administered to 100 patients with anorexia nervosa or bulimia nervosa and to 42 controls. The two groups differed significantly on all items. Five subscales were derived on rational grounds and evaluated on the two populations. The alpha coefficients for each subscale indicated a satisfactory degree of internal consistency. The EDE provides clinicians and research workers with a detailed and comprehensive profile of the psychopathological features of patients with eating disorders.

Purpose: The purpose of this article is to describe the international classification system proposed by the World Health Organisation for describing individuals with disability. Initially the 'International classification of impairment, disability and handicap' (ICIDH) was used. This has been replaced by the 'International classification of functioning, disability and health' (ICF). Both of these systems will be described and followed by a discussion of the advantages and disadvantages of using the WHOs classification framework. An application to the field of severe disability will be made throughout.
Method: Providing a theoretical framework for classification of disability in accordance with the system proposed by the WHO.
Results: The ICF is a useful tool that contributes to uniformity of international terminology and standardization in the disability field. It is not a minority model, and focuses on strengths and skills.
Conclusions: An international classification system such as the ICF offers a conceptual framework for information that is relevant to the long-term consequences of disability. Although any type of classification system has certain limitations, the advantages present within the ICF outweigh the limitations.

OBJECTIVE:
The worldwide prevalence estimates of attention deficit hyperactivity disorder (ADHD)/hyperkinetic disorder (HD) are highly heterogeneous. Presently, the reasons for this discrepancy remain poorly understood. The purpose of this study was to determine the possible causes of the varied worldwide estimates of the disorder and to compute its worldwide-pooled prevalence.

METHOD:
The authors searched MEDLINE and PsycINFO databases from January 1978 to December 2005 and reviewed textbooks and reference lists of the studies selected. Authors of relevant articles from North America, South America, Europe, Africa, Asia, Oceania, and the Middle East and ADHD/HD experts were contacted. Surveys were included if they reported point prevalence of ADHD/HD for subjects 18 years of age or younger from the general population or schools according to DSM or ICD criteria.

RESULTS:
The literature search generated 9,105 records, and 303 full-text articles were reviewed. One hundred and two studies comprising 171,756 subjects from all world regions were included. The ADHD/HD worldwide-pooled prevalence was 5.29%. This estimate was associated with significant variability. In the multivariate metaregression model, diagnostic criteria, source of information, requirement of impairment for diagnosis, and geographic origin of the studies were significantly associated with ADHD/HD prevalence rates. Geographic location was associated with significant variability only between estimates from North America and both Africa and the Middle East. No significant differences were found between Europe and North America.

CONCLUSIONS:
Our findings suggest that geographic location plays a limited role in the reasons for the large variability of ADHD/HD prevalence estimates worldwide. Instead, this variability seems to be explained primarily by the methodological characteristics of studies.

Abstract
PROBLEM:
There is a lack of information about the bereavement experiences of adolescents living in poverty in the inner city.
SUBJECTS:
Eight bereaved adolescents (mean age = 13.5 girls, 3 boys), from poverty-level families, attending an inner city junior high school.
METHODS:
A descriptive design, using participant-observation in a semi-structured group setting, data were gathered using audiotape recordings of the eight group discussions.
FINDINGS:
Chaos and stress were major themes pervading each discussion session. Lack of family and social support, fear for their future, and avoidance as the major coping strategy were also themes of the study.
CONCLUSIONS:
Inner city adolescents need to be assessed for loss of significant others. Provision of mental health services in schools could provide intervention services to current and future problems.

In recent years there has been a rapid growth of interest in the sociological study of childhood. This new book draws together the major developments in the field. In particular, the book discusses contemporary sociological and anthropological research in order to develop key links between the study of childhood and social theory, exposing its historical, political and cultural dimensions.

Abstract [en]

In order to better understand the context of suffering from dementia disorders, greater efforts should be made to understand and identify what persons with such disorders experience when living in a nursing home. The aim of this qualitative study was to gain further understanding of how persons with dementia disorders experienced and coped with their changed life situation after being relocated to a nursing home as described by their family members' perceptions. Qualitative data were collected from ten interviews with family members and evaluated using content analysis. The main findings suggest that residents with dementia disorders largely maintained their personality intact throughout the trajectory of illness as they were able to keep their habits and interests. The local environment of the nursing home and the residents' relationships to staff were important in order to feel accepted. Four categories were discerned during the analysis: living in limbo; coming to peace; keeping old habits and relationships; and thoughts about impending death. It is reasonable to believe that old habits and interests may be preserved as the embodiment of such habits are deeply rooted and connected to a person′s identity even when going through various changes and transitions in life. Therefore, to be accepted as the person you are requires care and services to specific needs, i.e. person-centeredness. Lack of understanding from staff may therefore have an adverse effect on a person's self-respect and identity. For that reason, staff needs to reflect on their attitudes and relationships as well as extending their knowledge about how to address sensitive topics such as the residents′ impending death. To achieve this support from managers is pivotal. Future research should focus on support to nursing staff to further knowledge and understanding about the individual changes resident go through near the end of life.

The absence of parents from schools is seen as an important factor related to the significant number of adolescents at risk of school failure. Effective parenting is known to be a key protective factor for adolescents at risk for school failure and other maladaptive developmental outcomes. While evidence-based parent management training models exist, their use has been limited by problems regarding recruitment and retention when services are offered through traditional means. We review the literature on parent involvement in schools, the effectiveness of parent education programs, and mutual aid activities. Logistical barriers to parent participation in parent management training programs and other school-related activities are examined, and a strategy using twenty-first-century technology will be described as a means to increase parent involvement in schools. (Contains 1 table.)

BACKGROUND:
Direct access to environmental stimuli and opportunity to ask for social contact/attention may be considered highly relevant objectives for persons with multiple disabilities. We assessed the possibility of enabling three of these persons (two children and one adolescent) to combine two microswitches (for accessing environmental stimuli) and a Voice Output Communication Aid (VOCA), which allowed them to ask for caregiver's attention.
METHODS:
Initially, the participants were required to use each of the two microswitches individually and then together. Thereafter, they were taught to use the VOCA. Eventually, the VOCA was available together with the microswitches, and the participants could use any of the three.
RESULTS:
The results, which support preliminary data on this topic, showed that all participants (1) were able to operate the two microswitches as well as the VOCA; and (2) used all three of them consistently when they were simultaneously available.
CONCLUSIONS:
Teaching persons with multiple disabilities to combine a VOCA with conventional microswitches may enrich their general input, emphasize their active social role and eventually enhance their social image.

BACKGROUND:
Direct access to environmental stimuli and opportunity to ask for social contact/attention may be considered highly relevant objectives for persons with multiple disabilities. We assessed the possibility of enabling three of these persons (two children and one adolescent) to combine two microswitches (for accessing environmental stimuli) and a Voice Output Communication Aid (VOCA), which allowed them to ask for caregiver's attention.
METHODS:
Initially, the participants were required to use each of the two microswitches individually and then together. Thereafter, they were taught to use the VOCA. Eventually, the VOCA was available together with the microswitches, and the participants could use any of the three.
RESULTS:
The results, which support preliminary data on this topic, showed that all participants (1) were able to operate the two microswitches as well as the VOCA; and (2) used all three of them consistently when they were simultaneously available.
CONCLUSIONS:
Teaching persons with multiple disabilities to combine a VOCA with conventional microswitches may enrich their general input, emphasize their active social role and eventually enhance their social image.

While previous literature on brain injury reports high levels of stress and burden in primary caregivers, the impact on children has been overlooked. This paper reports on an in-depth, qualitative research project exploring the experiences of four children living with fathers with an acquired brain injury (ABI). The findings indicate that these children were negatively impacted and at risk of emotional and behavioural difficulties. The children reported a complexity of feelings associated with the trauma and multiple losses, including profound grief, social isolation and fear of family disintegration and violence. Despite the difficulties they faced, the children also demonstrated resilience and reported positive outcomes such as having greater independence. Although only a small pilot study, the current findings highlight the need for both clinicians and researchers to be more proactive in questioning their clients and families about the level of violence following ABI and that disclosure may be more likely to occur with on-going involvement and support. The study concludes that early intervention and systemic support is required to minimize the trauma for these children. Further research is recommended, not only to replicate these findings in a larger sample, but also to explore in-depth children's experience of living with a parent with a brain injury.

The aim of this study was to explore how young (16-25 year old) informal carers of a person with a mental illness experience and use support. In a mixed method approach, we interviewed 12 young carers, and 241 completed a self-administered questionnaire. While the young carers strive to maintain control, their main support seems to be others in their lives, who often define the situation differently. The carers said web-support, counseling, and group counseling might be helpful, yet very few had any professional support. Young carers are greatly in need of support and it should be provided.

Abstract 
The aim of this review was to describe research related to support interventions for adult family members of people with mental illness and the significance that support may have. The results indicate the importance of flexible and individualized forms of support from both professionals and people with personal experience as a family member of someone with mental illness. In many cases, the intervention studies revealed that family members' burden decreased, their knowledge of the disease and treatment increased, and their ability to cope with the situation was improved. The results highlight the importance of support both from professionals and peers.

Objective

The aim of this study was to examine what family caregivers of persons with dementia perceive as important types of support/services in relation to experienced negative impact (NI) due to the caregiver situation, and to investigate if caregivers receive the support/services perceived as important.
Method

The study was based on the Swedish part of the EUROFAMCARE project and included 110 caregivers of persons with dementia. Data were collected primarily through structured telephone interviews. The caregivers were divided into two groups, a higher NI group and a lower NI group, based on the NI scale from the COPE index.
Results

Getting information and having someone to talk to were perceived as very important types of support/services by the highest proportion of caregivers in both groups. Data indicated only one significant difference; a higher proportion of caregivers in the higher NI group reported being able to participate in activities outside of caring as very important. There was also an indication that a higher proportion of caregivers in the lower NI group perceived information about the disease as very important. Support/services perceived as important by the caregivers were received both to a high and a low degree.
Conclusion

The results from this study suggest that there is almost no difference between groups of caregivers experiencing higher and lower NI regarding their perception of what are important types of support/services. The caregivers rated different types of support/services within the areas of information, relief and counselling as very important. Copyright © 2009 John Wiley & Sons, Ltd.

Objective: To examine what family carers of persons with stroke impairment perceive as important support and service quality characteristics in relation to their experienced strain/burden, and to explore to what extent family carers receive support/services perceived as important. Design: Data from a cross-sectional study. Subjects: A sample of 183 family carers in Sweden, 64 experiencing lower and 119 experiencing higher strain/burden, a subsample of the EUROFAMCARE project. Methods: Carers were interviewed using a structured questionnaire. Results: There are few differences between carers experiencing high and low strain/burden in what they perceive and receive in terms of important support and service quality characteristics. Information, relief, and counselling support/services are highly valued. It is also important that services improve quality of life, and have good process qualities regarding interaction with staff and individualization. Most services regarded as important are received by less than 60% of carers. Conclusion: The variation is rather high on an individual level in terms of what carers regard as important, indicating that factors other than negative impact may influence their perceptions of support/service and service quality. Thus, it is important to know carers' perceptions in order to individualize support/service, and thus make it more available and efficient.

OBJECTIVE:
To examine what family carers of persons with stroke impairment perceive as important support and service quality characteristics in relation to their experienced strain/burden, and to explore to what extent family carers receive support/services perceived as important.
DESIGN:
Data from a cross-sectional study.
SUBJECTS:
A sample of 183 family carers in Sweden, 64 experiencing lower and 119 experiencing higher strain/burden, a subsample of the EUROFAMCARE project.
METHODS:
Carers were interviewed using a structured questionnaire.
RESULTS:
There are few differences between carers experiencing high and low strain/burden in what they perceive and receive in terms of important support and service quality characteristics. Information, relief, and counselling support/services are highly valued. It is also important that services improve quality of life, and have good process qualities regarding interaction with staff and individualization. Most services regarded as important are received by less than 60% of carers.
CONCLUSION:
The variation is rather high on an individual level in terms of what carers regard as important, indicating that factors other than negative impact may influence their perceptions of support/service and service quality. Thus, it is important to know carers' perceptions in order to individualize support/service, and thus make it more available and efficient.

BACKGROUND:
United Kingdom legislation and clinical standards for schizophrenia challenge nurses to re-examine the support that they provide to carers. Nurses are in a key position to provide this support but may lack the necessary skills to do so. The training programme evaluated in the present study aimed to address this problem.
STUDY AIM:
To evaluate change in clinical practice brought about by post-registration training for mental health nurses in supporting carers of people diagnosed with schizophrenia.
DESIGN/METHODS:
The study was undertaken in collaboration between the Universities of Dundee and Glasgow, and Tayside National Health Service (NHS) Trust (Scotland). Respondents were nine nurses who completed training and then delivered a planned programme of support to carers. Data on nursing practice were gathered through semi-structured interviews with nurses before training and after providing support. Following the support intervention, carers also commented on the nurses' practice.
FINDINGS:
Eight of the nine nurses reported changes in practice in five key areas: They built collaborative relationships with carers, developed a carer focused approach to their practice, acknowledged and supported the carer role, and made progress in identifying carer needs and accessing resources to meet these needs. Nurses experienced difficulties supporting carers who had mental health problems or previous negative experiences of services. Those who lacked community experience also found it difficult to adjust to working in a community setting. Although clinical supervision helped them to work through these difficulties, they remain largely unresolved.
CONCLUSIONS:
Findings from this study indicate that appropriate training may enable nurses to improve the support provided to carers of people diagnosed with schizophrenia. This study represents an important stage in determining the nature of support offered to carers by nurses. While developed to help nurses to meet clinical standards set for schizophrenia in the UK, findings may have clinical significance for nurses in other countries.

The Moving Parents and Children Together (M-PACT) programme is one of the growing number of interventions tailored to meet the multiple and complex needs of children and families affected by parental substance misuse. This paper pulls together the qualitative findings from 13 evaluated M-PACT programmes in England. Sixty-four families attended an M-PACT programme, including 82 children and 75 adults. Qualitative data were collected from 37 children, 36 adults and over 30 group facilitators. Six themes are discussed: engaging with M-PACT, shared experiences, understanding addiction, changes in communication, healthier and united families, and ending M-PACT. The majority of families benefitted in a range of ways from the programme: meeting others who were experiencing similar problems, greater understanding about addiction and its impact on children and families improving communication within the family. In many families there was more openness and honesty, stronger relationships and more time as families, and a reduction in arguments and conflict. The key findings are discussed in terms of the potential for interventions of this kind to reduce family-related harm from parental substance misuse.

Drawing on the results of community-based research with a local hospice organisation, this article addresses the need to enhance social support for caregivers of people with life-threatening illnesses. The goal of the research was to involve palliative care stakeholders in the identification, prioritisation and implementation of social support interventions for caregivers who provide palliative care support as hospice volunteers and as family members of those at end-of-life. Guided by a community-based participatory research approach, primary data were collected from 39 volunteer and family member caregivers through four focus groups and nine personal diaries in July 2008. Content analysis and modified constant comparison techniques resulted in emergent themes and priorities relating to challenges, existing coping strategies and resources, and potential support interventions. The findings revealed communication, emotional support, education, advocacy and personal fatigue as the most important challenges to be addressed through support interventions at the organisational (professional support, volunteer mentoring and continuing education) and household levels (caregiver assessments, telephone support and follow-up). There was convergence in how caregivers perceived and access existing social supports, yet a crucial divergence in the availability of resources among volunteers and family members. The findings are discussed in the light of the capacity for hospices to implement social supports and the potential efficacy of the community-based participatory research approach for enhancing social support for caregivers in other parts of health-care and social care.

The overall aim of this thesis was to investigate how persons with dementia and their informal caregivers do every day activities together and to evaluate the result from an intervention designed to encourage mutual engagement. The sample in all four studies consisted of 30 cohabiting couples, where one part was a healthy spouse caring for a partner diagnosed with mild to moderate stage dementia. Study I had a twofold focus: to identify the supportive acts that caregivers spontaneously use in everyday occupations, as well as to describe the consequences of those acts on the person with dementia. Study II describing the individual participants perception of their own, their spouses and their mutual engagements in everyday occupations. In Study III and IV a home-based collaborative intervention including training on a functional as well as activity level, was evaluated. In Study III the effects of the intervention was evaluated through assessing the individual and mutual episodic memory-functions in the persons with dementia and their caregivers. In Study IV the intervention effect on caregivers communication and interaction skills when performing an everyday occupation together with their spouses with dementia was evaluated. The findings in Study I showed that the caregivers to the persons with dementia used a wide range of supports when working together with their partners. Most of these supports were shown to be beneficial to the occupational performance of the person with dementia, although some support that had negative impact on the performance of the latter was identified. The findings in Study II showed that both spouses perceived a loss of social and activity engagements as a consequence of the changes due to one having dementia. The caregivers described dilemmas they faced, but they also had management approaches to handle the altered everyday life. The results in Study III and IV showed that the collaborative intervention had a positive effect on the individual memory-performance of the persons with dementia. Also, Study III showed that the persons with dementia had a learning potential regarding individual episodic memory-functions when included in collaboration. In conclusion, the findings of these studies showed that the persons with dementia and their spouses engagements in everyday occupations were perceived as altered by both of them. The caregivers and the persons with dementia demonstrated different resources in finding strategies to solve the consequences of dementia in their everyday life. The identification of how persons with dementia and their spouses can learn strategies to collaborate might be useful in designing future interventions.

Children with complex communication needs (CCN) resulting from autism spectrum disorders, cerebral palsy, Down syndrome and other disabilities are severely restricted in their participation in educational, vocational, family, and community environments. There is a substantial body of research that demonstrates convincingly that children with CCN derive substantial benefits from augmentative and alternative communication (AAC) in their development of communication, language and literacy skills, with no risk to their speech development. Future research must address two significant challenges in order to maximize outcomes for children with CCN: (1) investigating how to improve the design of AAC apps/technologies so as to better meet the breadth of communication needs for the diverse population of children with CCN; and (2) ensuring the effective translation of these evidence-based AAC interventions to the everyday lives of children with CCN so that the possible becomes the probable. This article considers each of these challenges in turn, summarizing the state of the science as well as directions for future research and development. © 2012 Copyright 2012 RESNA.

Children with complex communication needs (CCN) resulting from autism spectrum disorders, cerebral palsy, Down syndrome and other disabilities are severely restricted in their participation in educational, vocational, family, and community environments. There is a substantial body of research that demonstrates convincingly that children with CCN derive substantial benefits from augmentative and alternative communication (AAC) in their development of communication, language and literacy skills, with no risk to their speech development. Future research must address two significant challenges in order to maximize outcomes for children with CCN: (1) investigating how to improve the design of AAC apps/technologies so as to better meet the breadth of communication needs for the diverse population of children with CCN; and (2) ensuring the effective translation of these evidence-based AAC interventions to the everyday lives of children with CCN so that the possible becomes the probable. This article considers each of these challenges in turn, summarizing the state of the science as well as directions for future research and development.

Argues that the well-documented sex difference in depression may be due to a sex difference in susceptibility, in precipitating factors, or in both. Data from a large mental health survey (2,515 White over-18 residents of 2 cities) were used to study precipitating factors. It was found that women were exposed more often to more of the factors that relate to depression; with a few exceptions, the factors related to depression similarly for men and women. Matching on these factors did not eliminate the sex difference in depression. This suggests that there may be a sex difference in susceptibility. Current theories of depression are incorporated into a sequential model of how learned factors might contribute both to susceptibility and to the sex difference. (14 ref) (PsycINFO Database Record (c) 2016 APA, all rights reserved)

In this study 165 Swedish parents of young children with Downs's syndrome (DS) were investigated regarding their perception of the quality of the first information and support received after the birth of the child. The parents' opinions were compared with clinical routines at the paediatric clinics regarding these issues. Strong clinical ambitions fell short, however, since 70 % of the parents felt insufficiently informed; 56 % felt unsupported, and the timing of the disclosure varied between 0 hour to >5 days. On the basis of a grounded theory analysis the parents' written narratives regarding the quality of the first information and support were analysed to better understand the reasons underlying the parental dissatisfaction. Criticisms were raised by the parents concerning: the low communication skills by professionals; the lack of privacy; too much negative information; and an unmet desire to early meet other DS parents. The implications of being DS parents regarding their daily life were examined by measuring parental health, stress, sense of coherence, employment and sick leave rates. Results were compared with those in a randomly selected group of parents of healthy age-matched children. The similarities between the DS and control parents were more pronounced than the differences regarding divorce rates, siblings in the family, time spent on child care, employment and sick leave rates, and their self-perceived health, stress, and sense of coherence. However, self-perceived health of the DS mothers was impaired and stress was increased. A small group of DS parents (5 mothers and 1 father) had an extremely high rate of sick leave and no such group was seen in the control parents. In addition, the DS mothers stayed at home because of the child's sickness most frequently and the DS fathers stayed at home for this reason more than control mothers.Conclusions: Existing guidelines for optimal first information and support of new parents of children with DS are not always followed in Sweden. Qualitative clinical improvements from the parents' perspective are proposed. Most DS parents live an ordinary family life in respect to the measured parameters, but the risk for health deterioration, particularly in DS mothers, might need attention

In this article, originally submitted to B J S E's Research Section, Chris Abbott of King's College, London, and Helen Lucey of the Open University report on the outcomes of a survey of special schools in England. The aim of the research, funded by the Nuffield Foundation, was to understand the nature and extent of symbol use for communication and literacy. A questionnaire was used to collect data on topics including: the types of symbols in use; the methodologies operated; ownership of symbol choice; and agreed policies within and outside school. The researchers had an excellent response in this important survey, undertake n after a period of rapid growth in symbol use in special schools and elsewhere. Chris Abbott and Helen Lucey provide a discussion of the results of their survey and of the issues that arise from the findings and the many comments added by respondents. They close their article with a call for further detailed research, both in the UK and in co-operation with practitioners in other countries, into the ways in which symbol use can meet the needs of learners.

Abstract
BACKGROUND:
The death of a parent is a major family disruption that can place children at risk for later depression and other mental health problems.
DESIGN:
Theoretically based randomized controlled trial for parentally bereaved children.
SETTING/PARTICIPANTS:
Two-hundred and forty-four children and adolescents and their caregivers from 156 families were randomly assigned to the Family Bereavement Program (FBP) intervention condition (90 families; 135 children) or to a control condition (66 families; 109 children). Data collection occurred from 1996 to 1998.
INTERVENTION:
Children and caregivers in the intervention condition met separately for 12 two-hour weekly sessions. Skills targeted by the program for children included positive coping, stress appraisals, control beliefs, and self-esteem. The caregiver program targeted caregiver mental health, life stressors, and improved discipline in the home. Both child and caregiver programs focused on improved quality of the caregiver-child relationship.
MAIN OUTCOME MEASURES:
Child and caregiver reports of internalizing and externalizing symptoms.
RESULTS:
Longitudinal growth curve modeling was performed to model symptoms over time from the point of parental death. The rate of recovery for girls in the program condition was significantly different from that of girls in the control condition across all outcomes. Boys in both conditions showed reduced symptoms over time.
CONCLUSIONS:
The methodology offers a conceptually unique way of assessing recovery in terms of reduced mental health problems over time after an event and has contributed to further understanding of FBP intervention effects. The intervention program facilitated recovery among girls, who did not show reduction in behavior problems without the program, while boys demonstrated decreased symptoms even without intervention.

Abstract
BACKGROUND:
The death of a parent is a major family disruption that can place children at risk for later depression and other mental health problems.
DESIGN:
Theoretically based randomized controlled trial for parentally bereaved children.
SETTING/PARTICIPANTS:
Two-hundred and forty-four children and adolescents and their caregivers from 156 families were randomly assigned to the Family Bereavement Program (FBP) intervention condition (90 families; 135 children) or to a control condition (66 families; 109 children). Data collection occurred from 1996 to 1998.
INTERVENTION:
Children and caregivers in the intervention condition met separately for 12 two-hour weekly sessions. Skills targeted by the program for children included positive coping, stress appraisals, control beliefs, and self-esteem. The caregiver program targeted caregiver mental health, life stressors, and improved discipline in the home. Both child and caregiver programs focused on improved quality of the caregiver-child relationship.
MAIN OUTCOME MEASURES:
Child and caregiver reports of internalizing and externalizing symptoms.
RESULTS:
Longitudinal growth curve modeling was performed to model symptoms over time from the point of parental death. The rate of recovery for girls in the program condition was significantly different from that of girls in the control condition across all outcomes. Boys in both conditions showed reduced symptoms over time.
CONCLUSIONS:
The methodology offers a conceptually unique way of assessing recovery in terms of reduced mental health problems over time after an event and has contributed to further understanding of FBP intervention effects. The intervention program facilitated recovery among girls, who did not show reduction in behavior problems without the program, while boys demonstrated decreased symptoms even without intervention.

Många barn med flerfunktionsnedsättning behöver synstimulering. Handboken Synstimulering – den tidiga utvecklingen av Gunilla Jangdin går igenom det lilla barnets synutveckling och visar hur synstimulans och samspel kan utvecklas trots omfattande flerfunktionsnedsättning i kombination med en synskada. Det är en lättläst och mycket användbar bok för alla föräldrar som vill förstå och stimulera sitt barns utveckling.

Background Mood and anxiety disorders, and problems with self-harm are significant and serious issues that are common in young people in the Criminal Justice System. Aims To examine whether interventions relevant to young offenders with mood or anxiety disorders, or problems with self-harm are effective. Method Systematic review and meta-analysis of data from randomised controlled trials relevant to young offenders experiencing these problems. Results An exhaustive search of the worldwide literature (published and unpublished) yielded 10 studies suitable for inclusion in this review. Meta-analysis of data from three studies (with a total population of 171 individuals) revealed that group-based Cognitive Behaviour Therapy (CBT) may help to reduce symptoms of depression in young offenders. Conclusions These preliminary findings suggest that group-based CBT may be useful for young offenders with such mental health problems, but larger high quality RCTs are now needed to bolster the evidence-base.

Post-traumatic stress disorder (PTSD) widely occurs among victims or witness of disasters. With flashbacks, hyperarousal, and avoidance being the typical symptoms, PTSD became a focus of psychological research. The earthquake in Wenchuan, China, on May 12, 2008, was without precedent in magnitude and aftermath and caused huge damage, which drew scientists' attention to mental health of the survivors. We conducted a systematic overview by collecting published articles from the PubMed database and classifying them into five points: epidemiology, neuropathology, biochemistry, genetics and epigenetics, and treatment. The large body of research during the past 6 years showed that adolescents and adults were among the most studied populations with high prevalence rates for PTSD. Genomic and transcriptomic studies focusing on gene × environment studies as well as epigenetics are still rare, although a few available data showed great potential to better understand the pathophysiology of PTSD as multifactorial disease. Phytotherapy with Chinese herbs and acupuncture are rarely reported as of yet, although the first published data indicated promising therapy effects. Future studies should focus on the following points: (1) The affected populations under observation should be better defined concerning individual risk factor, time of observation, spatial movement, and individual disease courses of patients. (2) The role of social support for prevalence rates of PTSD should be observed in more detail. (3) Efficacy and safety of Chinese medicine should be studied to find potential interventions and effective treatments of PTSD.

Post-traumatic stress disorder (PTSD) widely occurs among victims or witness of disasters. With flashbacks, hyperarousal, and avoidance being the typical symptoms, PTSD became a focus of psychological research. The earthquake in Wenchuan, China, on May 12, 2008, was without precedent in magnitude and aftermath and caused huge damage, which drew scientists' attention to mental health of the survivors. We conducted a systematic overview by collecting published articles from the PubMed database and classifying them into five points: epidemiology, neuropathology, biochemistry, genetics and epigenetics, and treatment. The large body of research during the past 6 years showed that adolescents and adults were among the most studied populations with high prevalence rates for PTSD. Genomic and transcriptomic studies focusing on gene × environment studies as well as epigenetics are still rare, although a few available data showed great potential to better understand the pathophysiology of PTSD as multifactorial disease. Phytotherapy with Chinese herbs and acupuncture are rarely reported as of yet, although the first published data indicated promising therapy effects. Future studies should focus on the following points: (1) The affected populations under observation should be better defined concerning individual risk factor, time of observation, spatial movement, and individual disease courses of patients. (2) The role of social support for prevalence rates of PTSD should be observed in more detail. (3) Efficacy and safety of Chinese medicine should be studied to find potential interventions and effective treatments of PTSD.

I slutet av 2012 kom Socialstyrelsen ut
med rapporten Effekter av stöd till anhö
-
riga som vårdar äldre med demenssjukdom
eller sköra äldre – en systematisk översikt.
Syftet med översikten var att utvärdera effekter
av utbildningsprogram, psykosocialt
stöd och kombinationsprogram som ges till
anhöriga som vårdar sköra äldre eller äldre
med demenssjukdom. I översikten under
-
söktes enbart studier som mätt effekter både
för den anhöriga och för
den närstående sjuka.

En minnesbok för barn som förlorat en förälder, ett syskon eller någon annan närstående.

I boken finns frågor att skriva svar på, och svaren blir en hjälp att minnas. Här finns också plats att rita bilder och klistra in foton. Och många värdefulla tips, till exempel om att prata med andra som kände den saknade och kanske be någon av dem att skriva något.

Att arbeta med boken innebär att arbeta med sina minnen - både glada och svåra - och sin sorg över den man saknar. Boken innehåller texter och illustrationer från personer som själva förlorat någon närstående, t ex Barbro Lindgren, Pernilla Stalfelt och Ilon Wikland.

Boken ger dig tips och råd när du ska välja äldreomsorg - åt dig själv eller åt en närstående. Den är lätt att slå i och kan läsas från början till slut eller i valda delar beroende på dina behov eller önskemål. Vad finns det för olika slags hjälp att få? Vad har du för rättigheter och vad är rimligt att begära? Vad är viktigt att tänka på när du ska välja mellan olika utförare? Vad gör du som anhörig om du inte är nöjd med den vård som din närstående får? Dessa frågor och många fler besvaras i boken. Precis som vi behöver information inför till exempel föräldraskap och skolstart behöver vi också vägledning inför ålderdomen. Det kan vara mycket att sätta sig in i, men med boken Så väljer du rätt äldreomsorg får du en bra översikt och en god förberedelse inför dina vägval.

Så väljer du rätt äldreomsorg - en guide för äldre och anhöriga är en enkel och matnyttig guide för dig som funderar på hur du vill ha det när du blir äldre.

Boken ger dig tips och råd när du ska välja äldreomsorg - åt dig själv eller åt en närstående. Den är lätt att slå i och kan läsas från början till slut eller i valda delar beroende på dina behov eller önskemål. Vad finns det för olika slags hjälp att få? Vad har du för rättigheter och vad är rimligt att begära? Vad är viktigt att tänka på när du ska välja mellan olika utförare? Vad gör du som anhörig om du inte är nöjd med den vård som din närstående får? Dessa frågor och många fler besvaras i boken.

Precis som vi behöver information inför till exempel föräldraskap och skolstart behöver vi också vägledning inför ålderdomen. Det kan vara mycket att sätta sig in i, men med boken Så väljer du rätt äldreomsorg får du en bra översikt och en god förberedelse inför dina vägval.

Claes Björck är beteendevetare och konsult med lång erfarenhet som chef både inom den kommunala och inom den privata äldreomsorgen. Anna Bidö är frilansjournalist med många års erfarenhet av arbete som vårdbiträde inom äldreomsorgen.

Målet med Lagen om stöd och service för vissa funktionshindrade, LSS, är att den enskilde får möjlighet att leva som andra. Genom speglingar av parallella plan; den officiella lag- och konventionstexten; forskning; gestaltade vardagssituationer och dagboksutdrag, undersöker författaren vad LSS innebär i praktiken.

Förutom LSS' honnörsord leva som andra; delaktighet; integritet; självbestämmande och kontinuitet, berörs även angelägna frågor som bemötande; hälsa; kommunikation; att vara anhörig (föräldra- och syskonperspektivet) och acceptans av en annorlunda livssituation.

"Så är det", som Simon ofta säger när han, lite förnöjt, konstaterar att saker och ting förhåller sig på ett visst sätt.

Boken vänder sig i första hand till dig som i ditt arbete möter barn eller vuxna med utvecklingsstörning och deras anhöriga. En annan viktig målgrupp är beslutsfattare; politiker och chefer.

Eva Borgström är socionom med lång erfarenhet av arbete inom funktionshinderrörelsen. Hon är också mamma till bokens huvudperson, Simon.

Studien omfattar huvudsakligen rapporter från Skolverket och Myndigheten för skolutveckling och svenska avhandlingar. Studien knyter an till Skolverkets skrift Allmänna råd för arbete med åtgärdsprogram genom att studien tar upp en stor del av den forskning och utvärdering som ligger till grund för de Allmänna råden. Skriften vänder sig både till skolansvariga i kommunen och till skolledare och lärare i skolan

Den här skriften vill visa hur alla de olika insatser som görs för barn och unga med funktionshinder kan samverka för att vara väl sammansatta, komma i rätt tid och överensstämma med barnets och ungdomens faktiska behov vid det aktuella tillfället. För att det ska vara möjligt måste alla de verksamheter och professionella som ger stöd se helheten i barnets situation, den helhet som vardagen utgör. Med ett sådant perspektiv och med en förståelse för den egna verksamhetens roll i helheten, finns en grund för att ta ansvar för samverkan.

I rapporten redovisas kunskap om metoder och modeller för barnhälsovårdens arbete med att förebygga och ge tidiga insatser mot psykisk ohälsa hos barn 0–5 år. Rapporten är baserad på systematiska kunskapsöversikter som är publicerade i internationella vetenskapliga tidskrifter.

Denna rapport presenterar evidens för insatser till barn i förskoleåldern på tidig kommunikativ nivå med syfte att ge rekommendationer till svensk habiliteringsverksamhet. Utifrån en formulerad fiktiv frågeställning utförde gruppen sökningar i vetenskapliga databaser. Några svenska rapporter och magisterarbeten har också inkluderats i granskningen.

Gunilla Thunberg, logoped och fil Dr på DART har på updrag av Sveriges Habiliteringschefers förening lett en grupp som sammanställt evidens för tidiga språk- och kommunikationsinsatser till förskolebarn inom barnhabilitering. Gruppen är nu färdig med sitt arbete och den 1/4 publicerades rapporten och rekommendationerna på Sveriges Habiliteringsschefers förenings hemsida. Det finns mycket spännande att ta del av när det gäller tidiga AKK-insatser så missa inte denna viktiga rapport! Du hittar den och kan ladda ner den här:

Föreningen Sveriges Habiliteringschefer har som uppgift att verka för en utveckling av habiliteringsverksamheten för barn, ungdomar och vuxna utifrån de övergripande mål som beskrivs i hälso- och sjukvårdslagen, lagen om särskilt stöd och service till vissa funktionshindrade samt föreskriften God Vård, SOSFS 2005:12. Föreningen ska på olika sätt stimulera forsknings- och utvecklingsarbete. Våra verksamheter riktar sig till en grupp barn, ungdomar och vuxna i samhället med stora och komplicerade behov.

Föreningen har en ambition att gemensamt utveckla en kvalitetssäker och effektiv verksamhet. Effektivitet kan ses ur en traditionell kostnadsaspekt men också ur barnet/den vuxnes och anhörigas levnadsaspekt.

Det finns en flora av interventioner. Inom ett flertal områden behöver metoder, arbetssätt och behandlingsresultat för barn, ungdomar och vuxna med funktionsnedsättningar beskrivas och dokumenteras. För att med största möjliga säkerhet veta vad som ska utvecklas och vad som ska avvecklas krävs ett nationellt samarbete. 2001 initierades därför ett projekt som fick namnet Evidens Baserad Habilitering (EBH). Syftet var att pröva en nationell arbetsmodell bestående av övergripande arbetsgrupper med uppgift att granska olika interventioners evidens. Projektet har med tiden övergått till att bli ett vedertaget arbetssätt när det gäller att ta fram evidensläget för ett interventionsområde. Detta är den sjunde arbetsgruppen där arbetsmodellen har använts.

Arbetsgruppens uppgift har varit att:

göra en litteraturöversikt över aktuell forskning och erfarenhetsbaserade resultat avseende tidiga kommunikations- och språkinsatser till förskolebarn inom barnhabilitering,
utifrån överenskomna kriterier kritiskt granska de utvärderingar och studier som publicerats,
på ett lättfattligt sätt göra erhållna resultat tillgängliga i en rapport.
Rapporten var färdig i februari 2011 och en revidering är gjord september 2012.

Föreningen Sveriges Habiliteringschefer ställer sig bakom de rekommendationer som arbetsgruppen lagt fram. Rapporten bidrar till en fördjupad kunskap.

Ett stort tack till Anna Blomgren, Barbara Eberhart, Jessika Forsberg, Lena Nilsson, Maria Nolemo och Gunilla Thunberg för att ni med lust, energi och stort engagemang har gripit er ann uppgiften. Genom er granskning tydliggörs också behovet av fortsatta studier för att säkra en habilitering på säker grund.

Göteborg 2012-11-05

Anna Kågeson
Styrgruppen Evidensbaserad habilitering
Föreningen Sveriges Habiliteringschefer

I landets kommuner har sedan slutet av 1990-talet ett omfattande arbete utförts för att
utveckla stödet till anhöriga. För att dra lärdom utvecklingsarbetet har Nationellt
kompetenscentrum anhöriga (Nka) tagit initiativ till denna undersökning för att i samverkan
med åtta av landets FoU-enheter kartlägga och följa utvecklingen av stödet till anhöriga under
tre år i åtta kommuner.
Syftet med studien är att:
- Kartlägga innehållet i stödet till anhöriga, hur stödet organiseras, planeras, följs upp
och utvärderas inom områdena äldre, funktionshinder och individ- familjeomsorg samt
samverkan mellan kommun, landsting, ideella organisationer och andra aktörer inom
området.
- Undersöka hur de olika huvudintressenterna bedömer kvaliteten på stödet till anhöriga
- Under tre år följa utvecklingen i de kommuner/kommundelar som ingår i studien.
Stödet till anhöriga i de utvalda kommunerna har kartlagts år 2010 och år 2013 genom att ta
del av tillgängliga dokument, kommunernas hemsida och informationsblad samt intervjuer
med och enkätutskick till chefer och andra nyckelpersoner. Genom en enkätstudie med
uppföljande telefonintervjuer har anhörigas situation och syn på sitt stöd, undersökts vid två
tillfällen. Årligen genomfördes fokusgruppsintervjuer, en inom vardera äldre-,
funktionshinder- samt individ och familjeområdet med syftet att beskriva och följa
utvecklingen av stödet till anhöriga; vad som fungerade bra och mindre bra. I varje
fokusgrupp ingick personal, beslutsfattare och representanter från ideella sektorn.
I denna delrapport, som också är slutrapport för hela projektet, presenteras resultatet för den
sista kartläggningen, gällande år 2013. Utvecklingen av anhörigstödet under de senaste åren
beskrivs också genom en jämförelse av resultaten från de olika kartläggningarna.
Tyngdpunkten i denna sammanfattning ligger på denna jämförelse.
Resultat
Det har inte skett några omvälvande förändringar i anhörigstödet i Uppsala kommun som
helhet under åren 2010 till 2013, men utvecklingen har inte stått stilla. Medvetenheten om
vikten av ett anhörigperspektiv hade på flera håll ökat.
Anhörigcentrum genomgick under tidsperioden en stor organisationsförändring.
Verksamheten bedrevs under två år som projekt, för att sedan fortsätta med ettåriga avtal i
väntan på beslut om eventuell konkurrensutsättning. Kunskapen om Anhörigcentrums
existens ökade under undersökningsperioden i kommunen och allt fler anhöriga sökte sig dit.
Målgruppen förändrades genom att också inkludera anhöriga till personer på boenden.
Anhöriga till äldre personer var fortfarande den största målgruppen, men en ökning av
anhöriga till yngre personer och framför allt från psykiatri och socialpsykiatri kunde noteras.
Utformningen av stödet till anhöriga var i stort densamma, men förändrades i viss mån till
exempel genom att anhöriggrupperna vände sig till andra målgrupper, rekreationshelger
infördes och anhöriga fick möjlighet till juristhjälp. Behovsinventeringar gjordes årligen, men
på lite olika sätt och med olika fokus. Anhörigcentrum ingick vid tiden för kartläggning två i
kommunens Nöjd-Kund-Index. Samverkan med landstinget utvecklades under tidsperioden
med t.ex. bemanning av "anhörighörna" på Akademiska sjukhuset och Anhörigcentrum hade
också tagit en aktiv del i landstingets projekt för utveckling av anhörigstöd.
8
I Äldrenämndens uppdragsplaner var effektmålen desamma för anhörigstödet under
uppföljningstiden, men målvärdena för antalet personer som skulle använda sig av
anhörigstödet (läs Anhörigcentrum) ökade från år till år. I förfrågningsunderlaget gällande
hemvård hade nya ska-krav införts under en egen rubrik; Anhörigvänlig vård och omsorg.
Inom hemvården hade också anhöriga börjat uppmärksammas genom anhörigträffar
information med mera. Inom vård- och omsorgsboendena fortsatte anhörigstödet
huvudsakligen inom den palliativa och avancerade sjukvården, men nytt var att Silviasystrar
inom åtminstone ett annat boende hade introducerat anhöriggrupper. Ett omfattande
värdegrundsarbete genomfördes inom äldreomsorgen som också inkluderade anhörigfrågor.
I förfrågningsunderlagen för upphandling av LSS-boendeenheter hade år 2013 infogats, under
rubriken Anhöriga, specifika ska-krav rörande anhöriga som inte hade funnits tidigare. Inom
Affärsområde assistans hade en grupp chefer i utvecklingssyfte börjat arbeta med
anhörigfrågor och anhörigas delaktighet. Verksamheten för anställda anhöriga bedrevs med
höga ambitioner och engagemang. Affärsområdeschefen i Affärsområde barn, ungdom &
familj beklagade bristen på stöd till anhöriga till personer under 21 år. Några insatser inom
verksamheten hade blivit mer flexibla bland annat för att underlätta för anhöriga. Arbete med
Samordnad individuell plan (Sip) infördes under uppföljningstiden och detta trodde många
skulle underlätta anhörigas situation.
I måldokument från de båda åren lyftes helhetsperspektiv och familjens roll fram på likartat
sätt inom individ- och familjeområdet. I kommunens drogpolitiska program nämndes
anhöriga som målgrupp för verksamheten. Viktiga stödinsatser erbjöds under hela den
undersökta tidsperioden inom Råd- och behandlingsgruppen, Trappan och familjeenheterna.
Inom Affärsområde socialpsykiatri & beroende hade en ny form av utbildning skapats. Den så
kallade återhämtningsakademin som ämnade samla brukare, personal och anhöriga i
gemensamma utbildningar.
Resultaten från enkäten till de anhöriga skiljer sig inte i någon större omfattning mellan de
båda studerade åren. Det är relativt stora andelar av respondenterna som beskriver en
problematisk livssituation och resultaten antyder också att det är de känslomässiga
dimensionerna som kan kräva ytterligare stödinsatser.
Det mest slående resultatet i de båda intervjuundersökningarna var att de anhöriga var nöjda
med det stöd som de hade fått. Framför allt gällde detta Anhörigcentrums verksamhet.
Rapporten avslutas med en begreppsdiskussion. Orden anhöriga, närstående, anhörigstöd med
flera används på olikartade sätt. För att kunna beskriva, följa, jämföra och inte minst utveckla
innehållet i stödet till anhöriga krävs att begreppsapparaten utvecklas. Fördelar och nackdelar
med ett specialiserat centraliserat anhörigstöd i jämförelse med ett integrerat decentraliserat
stöd diskuteras vidare och vikten av att ett anhörigperspektiv och anhörigstöd implementeras i
hela socialtjänsten betonas. För detta krävs bland annat att anhörigfrågorna finns med i
styrdokumenten på alla nivåer och att utbildningsinsatser genomförs.
Uppsala kommun har i en nationell jämförelse legat långt framme i anhörigfrågor under en
lång tid. Klimatet för att bygga upp och utveckla ett (specialiserat) anhörigstöd har varit gott.
En förhoppning är att den positiva trenden kommer att fortsätta i vetskapen om att mycket
hitintills är gjort, men att de svåraste uppgifterna kanske återstår; att se till att
anhörigperspektiv och anhörigstöd integreras inom hela socialtjänsten.

Rapport från Allmänna Arvsfonden och FUB: för barn, unga och vuxna med utvecklingsstörning

Den studie som här presenteras har som syfte att undersöka personalgruppers syn på anhöriga och deras roll inom psykiatriska verksamheter i kommuner och landsting. Den erhållna kunskapen skall ligga till grund för planering av kompetensutvecklande insatser.De frågeställningar som behandlas i undersökningen är:
- Vilka erfarenheter finns av samverkan/möten med anhöriga?
- Hur ser personal på samverkan med anhöriga och anhörigas roll för brukare/patienter och verksamhet.
- Vilka kunskapsbehov finns gällande samverkan med anhöriga?
Ostrukturerade gruppintervjuer genomfördes med nio personalgrupper. Sammanlagt intervjuades tre grupper inom boendestöd, två grupper vid boenden, två grupper inom öppenvården, en individuell intervju inom slutenvården samt en grupp representerande träffpunkter. I denna rapport presenteras det empiriska materialet.

Den studie som här presenteras har som syfte att undersöka personalgruppers syn på anhöriga och deras roll inom psykiatriska verksamheter i kommuner och landsting. Den erhållna kunskapen skall ligga till grund för planering av kompetensutvecklande insatser.De frågeställningar som behandlas i undersökningen är:
- Vilka erfarenheter finns av samverkan/möten med anhöriga?
- Hur ser personal på samverkan med anhöriga och anhörigas roll för brukare/patienter och verksamhet.
- Vilka kunskapsbehov finns gällande samverkan med anhöriga?
Ostrukturerade gruppintervjuer genomfördes med nio personalgrupper. Sammanlagt intervjuades tre grupper inom boendestöd, två grupper vid boenden, två grupper inom öppenvården, en individuell intervju inom slutenvården samt en grupp representerande träffpunkter. I denna rapport presenteras det empiriska materialet.

Socialstyrelsen har haft regeringens uppdrag att kartl‰gga p vilket s‰ttlandstingens barn- och ungdomshabilitering ‰r tillg‰nglig fˆr barn och ung-domar i olika Âldrar med olika funktionshinder. Fˆr att skapa underlag fˆrarbetet har enk‰ter riktats till landstingen och till barn/ungdomar med fa-miljer som under fˆrsta halvÂret 2002 hade habiliteringsinsatser. En kvalita-tiv studie som omfattar tio familjer har ocks gjorts. Markˆr AB, ÷rebro haransvarat fˆr insamlingen och sammanst‰llningen av materialet, som finnspublicerat i tv rapporter.UtifrÂn den genomfˆrda enk‰ten till barn/ungdomar med familjer kan So-cialstyrelsen konstatera att mÂnga barn och ungdomar med funktionshinderfÂr en bra habilitering och rehabilitering. MÂnga ‰r nˆjda bÂde med innehÂll,omfattning, bemˆtande, inflytande och mˆjligheter att pÂverka. Men Social-styrelsen kan ocks konstatera att de brister som tidigare studier har visatfortfarande kvarstÂr. TillgÂngen till habilitering/rehabilitering ‰r oj‰mnt fˆr-delad, bÂde mellan olika delar i landet och mellan olika grupper av funk-tionshinder.Sammantaget ˆver landet tas alla grupper av barn/ungdomar med funk-tionshinder emot av landstingen fˆr habilitering, men en grupp som p ettst‰lle har god tillgÂng till habilitering kan i en annan del av landet saknaviktiga insatser. ƒven inom ett och samma landsting fˆrekommer betydandevariationer.TillgÂng till habilitering och rehabilitering. Grupper som vanligen hartillgÂng till habilitering/rehabilitering ‰r barn och ungdomar med utveck-lingsstˆrning, med rˆrelsehinder och med neurologiska skador och sjukdo-mar. Barn/ungdomar med brister i tillgÂng till habilitering ‰r framfˆr allt demed funktionsneds‰ttningar till fˆljd av ADHD, autismliknande tillstÂndoch autism. Barn med flera funktionshinder, medicinska funktionshinderoch vissa kommunikationshinder, t.ex. synskada och talsvÂrigheter, fÂr inteheller sina behov av habilitering/rehabilitering tillr‰ckligt v‰l tillgodosedda.Brist p underlag. Landstingen genomfˆr inga kartl‰ggningar fˆr attkunna redovisa och fˆlja vilka barn/ungdomar som har behov av habilite-ring/rehabilitering, hur mÂnga de ‰r, vilken Âlder de har eller vilka typer avfunktionshinder det ‰r frÂga om och hur behoven ser ut.Landstingen kan inte redovisa vilka resurser som riktas till habilite-ring/rehabilitering fˆr barn och ungdomar, varken i pengar eller personal.Inflytande och mˆjlighet att pÂverka. Den enskildes mˆjligheter att pÂ-verka sin habilitering/rehabilitering ‰r begr‰nsade. S‰rskilt tycks detta g‰llabarn vars fˆr‰ldrar inte ‰r fˆdda i Sverige, har lÂg utbildning och/eller lÂginkomst.Individuell habiliteringsplan. Individuella planer enligt h‰lso- och sjuk-vÂrdslagen anv‰nds s‰llan om man ser till landstingens alla verksamheter. Ifˆrsta hand ‰r det den verksamhet som ben‰mns barn- och ungdomshabilite-ring som arbetar med individuell habiliterings/rehabiliteringsplan.
8Samverkan. Det finns brister i samverkan, bÂde internt inom landstingenoch externt mellan landstingens olika verksamheter och t.ex. skolan.Rutiner fˆr kvalitetsutveckling saknas. MÂnga kliniker saknar doku-menterade rutiner fˆr att samla in information och synpunkter frÂn bar-nen/ungdomarna och deras familjer.Information. Familjerna anser ofta att den information som de fÂr frÂnlandstingen ‰r bristf‰llig.Bemˆtande. MÂnga fˆr‰ldrar upplever att det stˆd de fÂr ‰r otillr‰ckligt.Minst nˆjda med den habilitering de fÂr ‰r familjer d‰r barnet/ungdomen harflera funktionshinder. I undersˆkningen framtr‰der tydligt fˆr‰ldrarnask‰nsla av att sj‰lva tvingas vara drivande fˆr att f det stˆd som de behˆver.Personal. Fortfarande saknas tillgÂng till insatser frÂn flera yrkesgrupperfˆr att habilitering fˆr barn och ungdomar skall fungera v‰l, framfˆr alltlogopeder, men ocks psykologer, l‰kare, kuratorer och sjukgymnaster.Socialstyrelsen anser att habilitering/rehabilitering bˆr f en starkarest‰llning inom h‰lso- och sjukvÂrden.Socialstyrelsen bedˆmer att den lagstiftning som finns ‰r tillr‰cklig underfˆruts‰ttning att den till‰mpas. Socialstyrelsen bedˆmer att ytterligare utred-ning av omrÂdet i nul‰get inte skulle gagna barn och ungdomar med funk-tionshinder.Socialstyrelsen anseratt landstingen fˆr att kunna planera sin h‰lso- ochsjukvÂrd med utgÂngspunkt i befolkningens behov regelbundet bˆr genom-fˆra kartl‰ggning av vilka grupper av barn/ungdomar med funktionshindersom finns och hur deras behov ser ut.Landstingens olika verksamheter bˆr av ledningen ges tydliga uppdragom vilka grupper av funktionshindrade som de har ansvar fˆr.SjukvÂrdshuvudm‰nnen bˆr i forts‰ttningen redovisa vilka insatser somfinns fˆr olika grupper av funktionshinder i en s‰rskild organisationsplan.SjukvÂrdshuvudm‰nnen bˆr dessutom tydligt redovisa vilka resurser i formav pengar och personal som gÂr till habilitering/rehabilitering fˆr barn ochungdomar med funktionshinder.Enligt h‰lso- och sjukvÂrdslagen skall individuella habiliterings- och re-habiliteringsplaner erbjudas barn/ungdomar med funktionshinder och derasfamiljer. Det utvecklingsarbete som pÂgÂr n‰r det g‰ller individuell planenligt h‰lso- och sjukvÂrdslagen behˆver lyftas fram och fˆrst‰rkas.Kvalitetsarbetet bˆr ges en mera framtr‰dande st‰llning inom verksam-heter med ansvar fˆr habilitering/rehabilitering och hj‰lpmedel och huvud-m‰nnen bˆr stˆdja forskning och statistikinsamling inom omrÂdet.SjukvÂrdshuvudm‰nnen bˆr ocks verka fˆr att viktiga begrepp inom ha-bilitering och rehabilitering fˆrankras inom verksamheterna

Tillit ger reaktioner i hjärnan som påverkar känslan och därmed kroppen. Sådan förväntan och tillit har inte blivit medicinskt utforskad. Det har blivit allt svårare att avfärda skildringar av läkande ritualer och magi från andra länder som enbart anekdoter.
Boken vänder sig till medicin- och antropologistuderande och studenter inom vård och omsorg samt alla de som i olika befattningar och roller är verksamma inom vården.

"Att vara anhörig är att få höra an till någon, att vara närstående är
att få stå någon nära. Anhörigskap är för de flesta inte att vara en
resurs, en funktion eller en kategori. Anhörigskap är relation, en
relation till en annan människa som man vill ha i sin närhet och vara
nära." Så börjar inledningen till antologin om det obetalda
omsorgsarbetet.

Denna lägesrapport beskriver tillståndet och utvecklingen inom hälso- och sjukvården och socialtjänsten. Avsikten med rapporten är att ge en samlad bild av dessa områdens olika verksamheter. Sammanfattningen följer samma struktur som rapporten, som i sin tur bygger på kvalitetsmål och kvalitetsområden för vården och omsorgen. En mer grundlig beskrivning av kvalitetsmålen och kvalitetsområdena finns i rapportens inledning

Denna lägesrapport beskriver tillståndet och utvecklingen inom hälso- och sjukvården och socialtjänsten. Avsikten med rapporten är att ge en samlad bild av dessa områdens olika verksamheter. Sammanfattningen följer samma struktur som rapporten, som i sin tur bygger på kvalitetsmål och kvalitetsområden för vården och omsorgen. En mer grundlig beskrivning av kvalitetsmålen och kvalitetsområdena finns i rapportens inledning

Vid sorg och död är den första reaktionen, för många, att skydda sitt barn genom att inte tala om det.Författaren Ann-Kristin Lundmark vill med sin tredje bok i serien om 10-åriga Tina, Tina och mormor, öppna upp för samtal inom ämnet. Sorg kan inte undvikas och ett barn kan inte alltid skyddas, men genom att prata om det som en vägledning kan många frågor besvaras och bidra till en enklare sorgbearbetning.

Tina har en intensiv vår med kompisar, skola och fotbollsträning och hinner inte träffa sin mormor så mycket som vanligt. Tina får lite dåligt samvete. En kväll vaknar hon och behöver gå på toa, men när hon ska gå och lägga sig igen hör hon prat från köket. Tina får veta att mormor är sjuk i cancer och snart ska dö. Efteråt är ingenting riktigt som förut och hela Tinas tillvaro rasar samman!

Väldigt berörande! Ett barn, hans bror, en familj drabbad av cancer så nära beskrivet att det kryper under skinnet på läsaren. Hur jobbigt och oroligt det faktiskt är både i stort och smått i den situation familjen levt med under alla dessa år. Författaren speglar även väldigt väl hur viktigt det är med förtroende och bemötande inom vården. En bok av detta slag bör varje vårdarbetare läsa och lägga de insikter den ger i bakhuvudet för att bättre kunna förstå helhetssituationen för patienten och familjen.Nils Erik Svedlund, barnläkareMaria tar oss med i många års kamp med ett cancersjukt barn och deras vardag. Vi kommer nära förtvivlan, smärta och tristess men också hopp, glädje och en stark syskonrelation. En viktig bok, även för personal och vårdutbildningar!Angelica Lindberg, kuratorSå glad att denna ärliga och viktiga bok finns! Berättelsen gav mig en insikt och förståelse för hur livet kan te sig i en familj med ett cancersjukt barn! När jag läste Titanium var det som om jag själv fanns med i familjens vardag och närhet. Så levande, så äkta, både kärleksfullt och skrämmande. Vilken styrka, vilket tålamod, vilken förmåga att ta vara på det minsta lilla positiva trots det ofattbara som händer under cancerbehandlingen. En mycket varm, närvarande och viktig berättelse om en lång, återkommande kamp mot leukemi i unga år och de konsekvenser det får för alla i familjen. Men också vikten av att tänka på syskonen, att låta dem finnas med och få plats i den vardag som blivit. Titanium är en bok jag varmt vill rekommendera, särskilt till de som arbetar inom vård och skola.Anneli Träff, grundskollärare

Large proportions of people with dementia live at home and need help from a relative. The aim of the current study was to examine how people living with persons with Alzheimer's disease (AD) perceived everyday life aspects of food choices, cooking, and food-related work. The analyses are based on focus group interviews including women and men acting as caregivers to people with AD and living in Sweden. The main results identified from the data, were how cohabitants to persons with AD struggle with either taking on a new role as a food provider or extending it, but also how they tried to cope as carer, which entailed food being an important part of the treatment of the disease. Those expressing greatest concern were those perceiving themselves as inexperienced food providers and carers, which in this study were all men.

The general aim of this thesis is to reach a more insightful understanding of how help is actually worked out in the everyday life of older people when they can no longer manage on their own. The overall research question is how individuals, representing different perspectives in the help arrangement process, think and act in order to organise needed help as well as how they may themselves apprehend the functions of the help. It is a qualitative study, containing four papers looking at this issue from different perspectives: the older persons themselves, their next of kin who provide help and the municipal care managers who make decisions on formal help. The empirical material consists of qualitative interviews and participant observations with care managers, qualitative interviews with older people applying for formal eldercare, follow-up interviews with some of them and qualitative interviews with next of kin who provide help. The analysis of the material adopts an empirically oriented approach, involving several steps from open to focused coding. Earlier research and theory guided the analysis. The results show that older people strive to maintain control over their everyday life (Paper I). When they can no longer manage unaided, they use various strategies to maintain control and the feeling of autonomy. Well-functioning formal and informal networks (Paper III) allow individuals to sustain autonomy and control in old age even when they have to depend on help from others. The care managers endeavour to make both ends meet in the decision process (Paper II). They develop various techniques and struck a balance between diverse demands and expectations. Helping an older relative is connected with a multiplicity of motives and experiences (Paper IV). The next of kin act both as bridges and buffers between their older relative and formal eldercare. This thesis emphasises the important functions of both formal and informal help to older people. To outline the working forms and methods of collaboration between older people and their informal and formal support networks is an important challenge that needs further attention.

The general aim of this thesis is to reach a more insightful understanding of how help is actually worked out in the everyday life of older people when they can no longer manage on their own. The overall research question is how individuals, representing different perspectives in the help arrangement process, think and act in order to organise needed help as well as how they may themselves apprehend the functions of the help. It is a qualitative study, containing four papers looking at this issue from different perspectives: the older persons themselves, their next of kin who provide help and the municipal care managers who make decisions on formal help. The empirical material consists of qualitative interviews and participant observations with care managers, qualitative interviews with older people applying for formal eldercare, follow-up interviews with some of them and qualitative interviews with next of kin who provide help. The analysis of the material adopts an empirically oriented approach, involving several steps from open to focused coding. Earlier research and theory guided the analysis. The results show that older people strive to maintain control over their everyday life (Paper I). When they can no longer manage unaided, they use various strategies to maintain control and the feeling of autonomy. Well-functioning formal and informal networks (Paper III) allow individuals to sustain autonomy and control in old age even when they have to depend on help from others. The care managers endeavour to make both ends meet in the decision process (Paper II). They develop various techniques and struck a balance between diverse demands and expectations. Helping an older relative is connected with a multiplicity of motives and experiences (Paper IV). The next of kin act both as bridges and buffers between their older relative and formal eldercare. This thesis emphasises the important functions of both formal and informal help to older people. To outline the working forms and methods of collaboration between older people and their informal and formal support networks is an important challenge that needs further attention.

Abstract
Aim: To understand the experience of family members of an older relative who has had a fall which required medical attention.

Background: There is abundant bibliography in caregiving, but little is known about the problems faced by caregivers and how family members cope when their older relative has a fall.

Design: Qualitative study that used a symbolic interactionism perspective.

Methods: Twenty-two people with older relatives, who had had a fall and contacted health services in Spain, participated in the study. Data were obtained via written accounts, focus groups, and semi-structured interviews between February 2014 - December 2015. Analysis was guided by grounded theory procedures.

Results: With the fall, dependency becomes a complex issue for the family. To manage a complex dependency is the core issue that emerges from the data analysis. It depicts family efforts to assist their relative in gaining autonomy after a fall, in the best conditions they can provide. They do this with little guidance and support from healthcare professionals.

Conclusions: Guides and protocols for the care of a fragile older person, particularly after a fall, should not only include care but also support to caregivers. Health professionals and especially nurses need to be aware and respond to the family caregivers needs after a fall. To the fall prevention initiatives already in place, it must be added that those who support family members to cope with the care of an older person who has had a fall.

In many countries one approach to supporting family-and-friend caregivers is direct financial or monetary support. Debates about the benefits and consequences of such policies pervade the literature. Building on the premise that values underlie public policy, the paper examines four policy paradoxes in the literature and uses selected examples from an international policy analysis to illustrate the underlying objectives and values upon which many of the policies were developed. These include the responsibility to care, economic or social objectives, gender equity, and the autonomy of care receivers. The authors conclude that policy makers need to be cautious about the unintended effects of financial support policy and develop a menu of policies and services to support caregivers. Future policy development in Canada must enable legitimate choice across the life course and ensure that neither the caregiver nor the care receiver will experience short- or long-term financial consequences of his or her choice.

Many family caregivers of frail older adults postpone or decline accessible and affordable services such as respite, despite their acknowledgement of unmet needs for support and time away from the burdens and stress of caregiving. How caregivers perceive their need for services, and the factors that influence their decisions to use or not use services, remain poorly understood. This article reviews the literature on family caregiving and the complex interrelated factors that influence caregivers' choices regarding support services. It organizes these factors into four areas: (a) service characteristics, (b) personal predisposing factors that affect perceived need, (c) experiential coping and decisionmaking patterns, and (d) relational factors. It also examines the implications of this evidence for nursing assessments and interventions with frail older adults and their family caregivers..

Tourette syndrome (TS) affects people of all ages, with onset in early childhood and continuing through the different stages of the life cycle into adolescence and adults. This review focuses on barriers to diagnosis and challenges in the management of young patients with TS. Barriers to identification occur at multiple levels, including detection in the community setting (including schools), parents' help-seeking behavior, and cultural influences on such behavior, as well as diagnosis by the medical provider. Challenges to management include unfamiliarity of primary care providers, inconsistencies in the diagnosis and management plan, and failure to recognize comorbid conditions, as well as inadequate knowledge and lack of resources to effectively deal with comorbidities. In addition to the complexities posed by pharmacological interactions, there are unique psychosocial challenges experienced by young people with TS and their families. Effective communication and collaboration between families, health care providers, and school personnel, as well as supportive communities, are essential components of comprehensive management. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)

Abstract
OBJECTIVE:
The multiple risk factors for major depression are interrelated through poorly understood developmental pathways. In 2002, the authors presented a developmental model for major depression in women. Based on similar methods, they here present an analogous model for men.
METHOD:
Using data from 2,935 adult male twins, interviewed twice over a 2-4-year period, the authors constructed, by means of structural equation modeling, an integrated etiologic model for major depression that predicts depressive episodes over 1 year from 18 risk factors conceptualized as five developmental "tiers" reflecting childhood, early adolescence, late adolescence, adulthood, and the last year.
RESULTS:
The best-fitting model, including six correlations and 76 paths, provided a good fit to the data, explaining 49% of the variance in the liability to depressive episodes. The overall results, similar to those seen in women, suggest that the development of major depression results from the action and interaction of three broad pathways of internalizing symptoms, externalizing symptoms, and adversity. Childhood parental loss and low self-esteem were more potent variables in the model in men than in women. Genetic risks for major depression had a broader spectrum of action in men than in women. The pathway to major depression through externalizing symptoms was not more prominent in men than in women.
CONCLUSIONS:
Major depression in men, as in women, is an etiologically complex disorder influenced by risk factors from multiple domains that act in developmental time. The similarities in etiologic pathways to major depression for men and women outweigh the modest differences.

The purpose of this article is to examine how the field of mixed methods currently is being defined. The authors asked many of the current leaders in mixed methods research how they define mixed methods research. The authors provide the leaders' definitions and discuss the content found as they searched for the criteria of demarcation. The authors provide a current answer to the question, What is mixed methods research? They also briefly summarize the recent history of mixed methods and list several issues that need additional work as the field continues to advance. They argue that mixed methods research is one of the three major "research paradigms" (quantitative research, qualitative research, and mixed methods research). The authors hope this article will contribute to the ongoing dialogue about how mixed methods research is defined and conceptualized by its practitioners.

The Commission presents a set of guidelines as a framework for the Member States' flexicurity strategies.
The principles of flexicurity contribute to the modernisation of the European social models.
Concept of flexicurity
To be effective, labour market modernisation strategies must take into account the needs of employees and employers alike. The concept of flexicurity is therefore a global approach which favours:
•flexibility of employees, who must be able to adapt to labour market developments and achieve their professional transitions. Similarly, this approach must improve the flexibility of enterprises and work organisation in order to meet the needs of employers and to improve the balance between work and family life;
•security for employees, who must be able to progress in their professional careers, develop their skills and be supported by social security systems when they are not working.
Flexicurity strategies aim to reduce unemployment and poverty rates in the European Union (EU). In particular, they help to facilitate the integration of the most underprivileged groups on the labour market (such as the young, women, older workers and the long-term unemployed).

The causes and effects of marketization of public services have been analysed extensively in the literature, but there is relatively little research on how those policies impact on the development of new forms of governance, and the role of users in these new arrangements. This study reviews examples of competition, freedom of choice and personalized care in health and social services in England and Sweden, in order to examine the type of relationships emerging between the user/consumer vis-à-vis market driven providers and various agencies of the state under the marketized welfare. The article focuses on the possible roles users might assume in new hybrid arrangements between markets, collaborations and steering. A user typology: namely, that of a consumer, citizen, co-producer and responsibilized agent in various governance arrangements, is then suggested. The article concludes by arguing that pro-market policies instead of meeting the alleged needs of post-modern users for individualized public services are likely to promote a new type of highly volatile and fragile partnerships, and create a new subordinated user who has no choice but to 'choose' services they have little control over.

Caregivers of older adults provide a wide range of informal supports and services that enable older adults to continue living in the community. This study describes the use of a multicomponent intervention combined with a person-centered approach to assist caregivers of older adults in the community. Four hundred and eighteen caregiver and care recipient dyads participated in this study and their outcomes related to burden, depression, well-being, and care recipient functional status were evaluated. The findings suggest that adult child and spousal caregivers experience burden differently. Programs designed to support caregivers must tailor services to the unique needs of adult child and spousal caregivers.

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1748-3743.2007.00092.x Byline: Henrik Eriksson, Jonas Sandberg Keywords: caring; gender; informal care; nursing home Abstract: Objectives. The aim of this study is to describe, from a gender identity perspective, the experiences of older men involved in the process of caring for a partner at home and the placement into a nursing home. Background. Few studies have paid attention to the importance of gender when considering the social experiences of older men providing care for an ill spouse and finally placing a partner in a nursing home. Further understanding is much needed of how older men experience the process of caring for a spouse from a gender identity perspective. Design. A qualitative constructivist approach was adopted for this study. Participants. Data consists of interviews with seven men that have been informal carers and experienced the placement of their wife in a nursing home. Methods. Interviews were analysed with a constructivist approach. Results. The results indicate that men go through two transitions in their gender identity during the caregiving process and placement. From the mutual loving relationship of being a loving husband, the social responsibility of daily care of their wives changes the situation into that of being a caring husband, and finally with the move to a nursing home there is a transition from intimate care to a relationship based on friendship. Conclusions. The results show that older caregiving men undergo a process involving a reconstruction of gender identity. To formally recognize men's caring activities and to make them sustainable, we believe that men in an informal caring relationship need support. Relevance to clinical practice. Nurses need to recognize the identity struggles resulting in sadness and suffering that are related to changes in men's lives during the caregiving process. Understanding the dynamics and changes that occur when men take on a caring task is important for the development of their role as carers. Article History: Submitted for publication: 21 November 2006 Accepted for publication: 25 June 2007 Article note: Henrik Eriksson, Department of Caring and Public Health Sciences, Malardalen University, Box 325, 631 05, Eskilstuna, Sweden, Telephone: +46 16 153747, E-mail: henrik.eriksson@mdh.se

Data from the Australian Longitudinal Study on Women's Health were used to study the order of events leading to informal caregiving and changes in labour force participation in mid-aged women, taking into account health and socioeconomic status. This analysis included 9857 women who responded to the third (2001) and fourth (2004) surveys and provided data for the caring and employment variables used. Caring was defined as providing care for an ill, frail or disabled person at least 7h/wk. Between 2001 and 2004, the proportion of women caring increased from 12 to 14%. Paid employment participation decreased from 67 to 62% in 2004. Logistic regression model results show that taking up caring between 2001 and 2004 was not statistically significantly associated with employment status in 2001. Among women who took up caring, however, hours spent in paid employment in 2001 was negatively associated with hours spent caring in 2004. Amongst women working in 2001, taking up caring between 2001 and 2004 was associated with reduced participation in paid employment. In conclusion, among mid-aged women, transitions into caregiving were irrespective of time spent in paid employment, but were followed by a decrease in labour force participation. Policies could aim to support continuing labour force participation during caregiving by creating flexible working arrangements; re-employment programs could support women who quit work in getting back to paid employment after a period of caregiving

Data from the Australian Longitudinal Study on Women's Health were used to study the order of events leading to informal caregiving and changes in labour force participation in mid-aged women, taking into account health and socioeconomic status. This analysis included 9857 women who responded to the third (2001) and fourth (2004) surveys and provided data for the caring and employment variables used. Caring was defined as providing care for an ill, frail or disabled person at least 7h/wk. Between 2001 and 2004, the proportion of women caring increased from 12 to 14%. Paid employment participation decreased from 67 to 62% in 2004. Logistic regression model results show that taking up caring between 2001 and 2004 was not statistically significantly associated with employment status in 2001. Among women who took up caring, however, hours spent in paid employment in 2001 was negatively associated with hours spent caring in 2004. Amongst women working in 2001, taking up caring between 2001 and 2004 was associated with reduced participation in paid employment. In conclusion, among mid-aged women, transitions into caregiving were irrespective of time spent in paid employment, but were followed by a decrease in labour force participation. Policies could aim to support continuing labour force participation during caregiving by creating flexible working arrangements; re-employment programs could support women who quit work in getting back to paid employment after a period of caregiving

The need for evidence-based non-pharmacological community programs to improve care of older adults with dementia is self-evident, considering the sheer numbers of affected individuals; the emotional, physical, and financial toll on affected individuals and their caregivers; the impact on our health care system; and the growing availability of evidence regarding the potential for psychosocial interventions to enhance care and decrease costs. To address this need, the Administration on Aging has begun funding translation of evidence-based programs into community settings. Two programs, Reducing Disability in Alzheimer's Disease and STAR-Community Consultants (STAR-C), were selected by the Ohio Department of Aging (in collaboration with the Alzheimer's Association Chapters in Ohio) and the Oregon Department of Health Services (in partnership with Area Agencies on Aging and the Oregon Chapter of the Alzheimer's Association) to be implemented by their staff. Both programs are designed to improve care, enhance life quality, and reduce behavioral problems of persons with dementia and have demonstrated efficacy via randomized controlled trials. This article addresses the developmental and ongoing challenges encountered in the translation of these programs to inform other community-based organizations considering the translation of evidence-based programs and to assist researchers in making their work more germane to their community colleagues.

Purpose: A single-subject alternating treatment design was used to (a) evaluate the influence of translucency (i.e., the guessability of the symbol when the referent is known) and complexity (i.e., the number of lines or strokes that compose the symbol) on Blissymbol acquisition and (b) compare the effectiveness of computer-based instruction (CBI) and traditional teacher-based instruction (TBI) on students' accuracy in identifying Blissymbols.

Method: Three students with communication disorders were taught to identify 40 Blissymbols using the two instructional formats.

Results: Findings revealed that high translucency Blissymbols were learned significantly faster than low translucency Blissymbols for all participants. High complexity assisted learning when translucency was high, but hindered learning when translucency was low. These results were evident in both interventions.

Although the importance of iconicity in the learning of symbols has been widely acknowledged, there have been few systematic investigations into the influence of culture on the ratings of symbol iconicity. The purposes of this study were two-fold: to determine (a) the translucency ratings of specific Blissymbols as rated by 6- to 7-year-old Setswana-speaking children (one of South Africa's 11 official languages); and (b) whether the ratings changed after second and third exposures in order to determine the learnability of these symbols. This study is partially based on the study by Quist et al. (1998), which utilized Dutch and American participants. Thirty-four Setswana children were exposed to 93 selected Blissymbols. A 3-point semantic differential scale consisting of three faces accompanied each Blissymbol, without the written gloss. This procedure was repeated over a period of 3 days. The results indicated that the majority of Blissymbols were rated as having high translucency ratings. The research further demonstrated significant differences in translucency between first and second exposures, suggesting that learning of the symbols had occurred. The comparison between the results of the current study and the results reported in the Quist et al. study reveal that the translucency ratings of the majority of the selected Blissymbols ranged from moderate to high for all three studies, but that the distribution of symbols across the ratings appears to be different.

We reviewed nine studies evaluating the use of tangible symbols in AAC interventions for 129 individuals with developmental disabilities. Studies were summarized in terms of participants, tangible symbols used, communication functions/skills targeted for intervention, intervention procedures, evaluation designs, and main findings. Tangible symbols mainly consisted of three-dimensional whole objects or partial objects. Symbols were taught as requests for preferred objects/activities in five studies with additional communication functions (e.g., naming, choice making, protesting) also taught in three studies. One study focused on naming activities. With intervention, 54% (n = 70) of the participants, who ranged from 3 to 20 years of age, learned to use tangible symbols to communicate. However, these findings must be interpreted with caution due to pre-experimental or quasi-experimental designs in five of the nine studies. Overall, tangible symbols appear promising, but additional studies are needed to establish their relative merits as a communication mode for people with developmental disabilities.

Recent years have brought a dramatic rise in the number of efforts to measure and monitor the status of children. Yet, despite numerous efforts and reports with 'Child indicators' in the title, the field of social child indication is fragmented and lacking a unifying taxonomy. The more ambitious the analysis and the more elaborate the statistics, the stronger the need for a common language used by all. This article tries to suggest such a taxonomy.

Twenty-nine special education teachers (n=21) and speech-language pathologists (n=8) were interviewed about a tangible symbols intervention conducted with 51 children (321 years) with multiple disabilities and visual impairment. The intervention, which took place over a 7-month period, addressed the use of tangible symbols in the context of a structured protocol for implementing the daily schedule. These educators reported that students learned the meaning of symbols, exhibited improved behavior, and learned part or all of the daily routine, among other benefits. Supports and barriers to student learning (later coded as student characteristics or intervention characteristics) were discussed. Interviewees suggested improvements to the intervention and for generalization to the home setting, including labeling in the family's first language. © 2011 International Society for Augmentative and Alternative Communication.

We replicated and extended previous research on microswitch facilitated choice making by individuals with profound multiple disabilities. Following an assessment of stimulus preferences, we taught 6 adults with profound multiple disabilities to emit 2 different responses to activate highly preferred stimuli. All participants learnt to activate both microswitches. Five participants showed a higher overall level of responding when both switches activating preferred stimuli were available concurrently. After completion of microswitch training, a choice assessment was conducted in which participants had access to 2 microswitches concurrently, with 1 connected to the most highly preferred stimulus and the other to a least preferred stimulus. Choice making behavior was shown in 3 participants and provided support for the preference assessment results. The results of the 3 remaining participants showed that both the most highly preferred and the least preferred stimuli may serve as reinforcers for microswitch activation responses. © 2011 Elsevier Ltd.

I en språkutvecklande förskolemiljö ligger fokus på barncentrerad kommunikation där det vardagliga samspelet är grunden. Olika sätt att kommunicera tillåts och uppmuntras. Barn ges möjlighet att använda alla sinnen – kroppsspråk, minspel, röstläge, intonation, beröring, blickkontakt och tecken.

Boken handlar om hur användandet av TAKK stärker kommunikationen i förskolan. TAKK innebär att låna tecken från det svenska teckenspråket och använda dessa tecken som ett alternativ och ett komplement i det kommunikativa samspelet. De viktigaste orden i meningen förstärks med tecken samtidigt som vi talar.

Författaren ger inspiration och konkreta förslag för att komma i gång att arbeta med TAKK i förskolegruppen.

This article describes a nursing intervention called Teen Club that was designed to reduce risk-taking behavior and improve well-being in female African American adolescents. Participants were referred to Teen Club by their nurse practitioners, physicians, and a community health nurse who were working at an urban neighborhood health center's teen clinic. Referrals were based on factors such as parental substance abuse, lack of social and family support, and other characteristics thought to increase vulnerability to risk-taking behavior. The 2-year intervention included weekly group meetings co-led by a European American female community health nurse and a Latino American male community worker, supplemented by case management and home visits by both these persons. Findings from a retrospective group interview conducted with 11 of the 12 original participants are presented. This is the first step in a series of pilot studies designed to refine the Teen Club intervention in anticipation of a future prospective, randomized investigation of this health promotion and disease prevention model of nursing care.

This article describes a nursing intervention called Teen Club that was designed to reduce risk-taking behavior and improve well-being in female African American adolescents. Participants were referred to Teen Club by their nurse practitioners, physicians, and a community health nurse who were working at an urban neighborhood health center's teen clinic. Referrals were based on factors such as parental substance abuse, lack of social and family support, and other characteristics thought to increase vulnerability to risk-taking behavior. The 2-year intervention included weekly group meetings co-led by a European American female community health nurse and a Latino American male community worker, supplemented by case management and home visits by both these persons. Findings from a retrospective group interview conducted with 11 of the 12 original participants are presented. This is the first step in a series of pilot studies designed to refine the Teen Club intervention in anticipation of a future prospective, randomized investigation of this health promotion and disease prevention model of nursing care.

Objective: To examine the co-occurrence of physical teen dating violence (TDV) with other forms of victimization. Method: The sample includes 1,680 youth aged 12 to 17 from the National Survey of Children's Exposure to Violence (NatSCEV), a nationally representative telephone survey of victimization experiences. Results: Every victim of physical TDV (100%) reported at least one other type of victimization. Physical TDV is very closely associated with several other forms of victimization in this sample, with adjusted odds ratio ranging from 1.48 to 17.13. The lifetime rate of TDV was 6.4% for all youth, but TDV rates reached 17% for youth who had been physically abused by a caregiver, 25% for youth who had been raped, and 50% for youth (<16 years) who had experienced statutory rape or sexual misconduct by a partner more than 5 years older. Victims of TDV reported, on average, twice as many other types of victimizations as those with no history of TDV. Conclusions: These data indicate that physical TDV is especially closely associated with some forms of child maltreatment, sexual victimization, and polyvictimization. Universal dating violence prevention programs designed for youth who have not yet, or just recently, started dating will typically include a large number of youth who have already been victimized by other forms of violence. Prevention curricula may be more effective if they address the needs of victimized youth, for example, by teaching skills for coping with prior victimization experiences. (PsycINFO Database Record (c) 2013 APA, all rights reserved)

Teknik för äldre är ett regeringsuppdrag som samordnats av Hjälpmedelsinstitutet. Det har verkat sedan 2007 med en budget om 22 miljoner kronor årligen. Teknik för äldre har stöttat utvecklingen av bra produkter och tjänster som underlättar vardagen och boendet för äldre och anhöriga. Företag, organisationer och kommuner har kunnat ansöka om ekonomiskt stöd för att driva utvecklingsprojekt. 100 projekt har fått stöd inom Teknik för äldre I (2007-2009) och 61 projekt inom teknik för äldre II (2010-2012). Bidrag om sex miljoner kronor vardera har lämnats till kommunala försöksverksamheter i Göteborgs stad, Norrköpings kommun och Västerås stad. Inom Teknik för äldre II har projekt prioriterats som bidragit till tillgängligt boende, bättre stöd till anhöriga och utveckling av äldreomsorgen med hjälp av välfärdsteknologi. Informations- och kommunikationsinsatser har också varit i fokus.

Nationellt kompetenscentrum anhöriga fick i uppdrag av Hjälpmedelsinstitutet att under 2012 utvärdera tre projekt inom programmet, "Teknik för äldre II" som fokuserar på tekniskt stöd till anhöriga "Mitt i livet" som kombinerar förvärvsarbete med anhörigomsorg. Det första projektet, "Teknikstöd – ökad social interaktion mellan anhöriga mitt i livet", i Alingsås kommun implementerade det internetbaserade IT systemet "Gapet" för yrkesverksamma anhöriga. Det andra projektet, "Modell för virtuellt anhörigstöd" i Gävle kommun, utvecklade en modell och struktur för ett enhetligt virtuellt anhörigstöd som riktade sig till yrkesverksamma anhöriga vilket inkluderade den IT-baserade stödtjänsten "Anhörigstödsportalen". Det tredje projektet, "Teknikstöd för yrkesverksamma anhöriga – en behovsstudie, fokuserade på att utföra en inventering av yrkesverksamma anhörigas behov av ny teknik, utveckla en modell för teknikstöd riktat till yrkesverksamma anhöriga samt hitta vägar för att sprida kunskap för att öka målgruppens möjlighet att nås av teknikstöd. Detta område är särskilt viktigt därför att det i nuläget finns få stödtjänster, i Sverige men även internationellt, som är speciellt anpassade till yrkesverksamma anhöriga som hjälper, stödjer och/eller vårdar en äldre närstående. Många yrkesverksamma anhöriga uttrycker att de vill hjälpa sin förälder/sina föräldrar, men att det är svårt att uppnå en balansgång mellan arbetsliv och familjeliv samtidigt som man hjälper, stödjer och/eller vårdar en äldre närstående. Det är inte ovanligt att egen tid för avkoppling och välbefinnande blir alltmer sällan och prioriteras bort. Som en följd av detta upplever de yrkesverksamma anhöriga ofta stress för att de inte räcker till och ständigt behöver bolla mellan olika sfärer av sina liv. Den senaste statistiken från Socialstyrelsen visar att närmare 100 000 anhöriga har behövt minska sin arbetstid eller sluta arbeta pååtta procent män. Yrkesverksamma anhörigas behov kan sammanfattas med information, rådgivning och/eller utbildning/ träning, praktiskt samt känslomässigt stöd som är flexibelt och passar de egna rutinerna och den egna situationen. Mot denna bakgrund, utvecklades och diskuterades en utvärderingsplan med projektledarna tillsammans med den övergripande koordinatorn för initiativet "Teknik för Äldre II" vid det första gemensamma projektmötet och utvärderingen var en återkommande nyckelfråga vid efterföljande gemensamma projektmöten som hölls under året. Utvärderingen av projekt 1 och 2 genomfördes under hösten 2012 med en liknande utformning för båda projekten där en kvalitativ utvärdering genomfördes med hjälp av fokusgruppsintervjuer och individuella intervjuer och en kvantitativ utvärdering utfördes med hjälp av ett standardiserat frågeformulär om användbarhet. Utvärderingen av projekt 3 genomfördes kontinuerligt från starten till slutet av projektet. Detta berodde på att projektet var en behovsstudie som omfattade anhörigvårdare i en kontinuerlig utvecklingsprocess vilket betyder att det var olämpligt att genomföra en utvärdering under en specifik period vilket var fallet i de två första projekten. Resultaten från utvärderingarna av de första två projekten visar att teknikstöd har en stor potential avseende yrkesverksamma anhöriga då det erbjuder ett flexibelt sätt för anhöriga att få tillgång till information och en möjlighet för anhöriga att kunna utbyta erfarenheter med andra i samma situation och själva skapa stödnätverk. På samma gång erbjuder teknikstöd personalen att arbeta på ett systematiskt sätt med stöd till anhöriga. Men, för att teknikstöd ska användas av fler anhörigvårdare och för att det ska bli mer allmänt accepterat av personalen behövs det grundläggande datorutbildning för både anhöriga och vård- och omsorgspersonal samt kontinuerlig tillgång till handledning och stöd i användningen. Resultat som härrör från en utvärdering från behovsstudien (projekt 3) visar att utbudet av kreativa och sekventiella metoder som användes under utvecklingsprocessen möjliggjorde en genuin brukarmedverkan av yrkesverksamma anhöriga så att deras röster blev hörda gällande teknikstöd. Samtidigt kan dessa innovativa metoder bilda en användbar modell för vård- och omsorgs personal gällande hur anhöriga kan nås av stöd genom produkter, tjänster och ny teknik.

'Telecare solutions' are seen as a potential means of addressing the future care needs of ageing societies in Western economies. The development of these remote care systems runs in parallel with policies aimed at 'ageing in place'; and is targeted at supporting the perceived care needs of frail older people within the home. Drawing on ethnographic and deliberative panel data from European Community funded research, we consider how these developments contribute to a reshaping of the place and experience of care for older people. We do so by addressing the ways in which remote care systems can, firstly, act to change the experience of home; and secondly, re-order the place of care-work and responsibilities to care as new actors become enrolled within the care network and existing care-givers take on differing roles and responsibilities. Finally, we consider how this paper contributes to conceptual debates around institution and extitution -- that is, the de-territorialisation of the physical structure of the institution and its re-manifestation through new spaces and times that seek to end interior and exterior distinctions.

Drawing on interviews with 76 older people (aged 60 years and older) receiving telecare services at home and in housing with care and 16 family caregivers in West Lothian, Scotland, the authors consider how far telecare can support older people's citizenship goals of independence, participation, and identity. They conclude that although these goals are to some extent supported by telecare, they are also supported by the model of care being applied and limited by aspects of the wider environment, such as ageism. The authors argue that in every case, contextual factors beyond the intrinsic capacities of a technological system and beyond the models of care developed and promoted by a service delivery organization must be explored if the impact of telecare is to be fully understood. Thus, the human use of technology and its moral context are critical to its success or limitation.

Purpose: This study evaluated the effectiveness of telephone groups for older, spousal caregivers of stroke survivors. Method: The 88 caregivers were mostly white females who were 70 years old on average and who had been providing care for an average of 3 years. Participants were randomized to treatment or control conditions, followed for 6 months, and assessed for depression, burden, loneliness, stress, and competence. Treatment participants engaged in an eight-session psychoeducational telephone group. Results: Treatment participants showed decreased stress over time but were not significantly different from control participants in the amount of change in stress. Control participants showed a significant increase in burden during the study; treatment participants showed a significant increase in competence.

För att stödja anhöriga med behov av extra stöd i samband med en närståendes
flytt till äldreboenden erbjöd Östermalms stadsdelsförvaltning under 2011 anhörigstöd
i form av gruppsamtal, så kallat fördjupat anhörigstöd. Målet med det
fördjupade anhörigstödet var att stödja anhöriga som gått igenom den svåra
processen att fatta beslutet om närståendes flytt. En terapeut ledde sammankomsterna
och stadsdelsförvaltningens anhörigkonsulent var behjälplig i detta arbete.
Stiftelsen Äldrecentrum fick i uppdrag av Östermalms stadsdelsförvaltning att
göra en deskriptiv studie av deltagarnas erfarenheter av att vara med i pilotprojektet
med fördjupat anhörigstöd. Syftet var att beskriva vad det fördjupade
anhörigstödet innebär samt att redogöra för deltagarnas erfarenheter. De fem
anhöriga, samtliga kvinnor, som deltog i det fördjupade anhörigstödet intervjuades.
Intervjuer genomfördes även med ledarna för gruppsammankomsterna.
Ett fördjupat anhörigstöd är terapi, där det handlar om att få verktyg för att
kanske välja en annan väg och att gå vidare. Man berör tidigare upplevelser i livet
och kopplar dessa till den anhöriges nuvarande situation. I ett fördjupat anhörigstöd
får den anhörige hjälp att bearbeta sin situation, vilket möjliggör för deltagarna
att komma ur sin kris.
Inom ramen för det fördjupade anhörigstödet genomfördes totalt tio gruppsammankomster.
Deltagarnas erfarenheter av sammankomsterna visade bland
annat att:
 Samtliga deltagare var mycket nöjda med det fördjupade anhörigstödet
Träffarna beskrevs som innehållsrika och intensiva.
 Deltagarna lyfte fram det positiva med sammankomsterna dels den goda
sammanhållningen i gruppen dels ledarnas engagemang och stöd.
 Tre av deltagarna ansåg att de hade fått ut det de hoppades på av det
fördjupade anhörigstödet, en visste inte och en deltagare sa att hon tyckte att
det var positivt att gå dit och att hon hade mått bra i stunden.
När det fördjupade anhörigstödet avslutades erbjöds deltagarna att fortsätta sina
sammankomster själva. Samtliga deltagare har också möjlighet till fortsatt kontakt
med anhörigkonsulenten.
Möjligheten för anhöriga att få hjälp att bearbeta sorg och förlust behöver uppmärksammas
i större utsträckning i det anhörigstöd som ges. Pilotprojektet
"Fördjupat anhörigstöd" är en intressant stödform som visar att behov finns av
stöd till anhöriga i en svår och utsatt situation. Stödformen behöver prövas och utvecklas
ytterligare. Ett område att få mer kunskap om är hur stort behovet av
terapi är för att stödja anhöriga. Intressant vore att prova olika terapiformer. En
annan intressant utveckling skulle vara att genomföra ett fördjupat anhörigstöd i
samverkan mellan kommun och landsting.

The spouses of people suffering from dementia are commonly first-in-line caregivers. This can have a considerable effect on their own lives, health and marriages. Several studies have focused on spouses' experiences, but very few have focused in any depth on their descriptions of themselves as subjects. Therefore, the aim of this study is to describe how spouse caregivers can express themselves when living with and caring for their partners with dementia. The study has a qualitative approach with a discourse analysis design and uses analytical tools such as rhetoric, subject positions and categorization. The results reveal three subject positions: as an actor, as a parent and as a survivor. The results show that as spouses struggle with external and internal clashes as subjects, they therefore need to develop coping strategies. They also experience pronounced loneliness and a risk to their own health. There is thus a need to support these spouses as individuals in their differing and changing needs.

BACKGROUND:
This study examined the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood.
METHOD:
We analyzed data from published follow-up studies of ADHD. To be included in the analysis, these additional studies had to meet the following criteria: the study included a control group and it was clear from the methods if the diagnosis of ADHD included subjects who did not meet full criteria but showed residual and impairing signs of the disorder. We used a meta-analysis regression model to separately assess the syndromatic and symptomatic persistence of ADHD.
RESULTS:
When we define only those meeting full criteria for ADHD as having 'persistent ADHD', the rate of persistence is low, approximately 15% at age 25 years. But when we include cases consistent with DSM-IV's definition of ADHD in partial remission, the rate of persistence is much higher, approximately 65%.
CONCLUSIONS:
Our results show that estimates of ADHD's persistence rely heavily on how one defines persistence. Yet, regardless of definition, our analyses show that evidence for ADHD lessens with age. More work is needed to determine if this reflects true remission of ADHD symptoms or is due to the developmental insensitivity of diagnostic criteria for the disorder.

The AML, an l 1-item, 3-factor, quick-screening device for early school maladaptation is described. Test reliability data are reported as well as itemitem and item-scale correlations and factor analytic findings. Norms for Kindergarten-3rd grade are presented, and parametric studies are reported for the variables: sex, grade, and "repeat-in-grade" status. Five additional substantive studies, testifying to the concurrent and empirical validity of the scale, are summarized. Limitations in using the AML are considered. Given its brevity and objectivity, its greatest potentials are in mass, quick-screening of early school dysfunction.

The overall aim of the thesis, with four empirical studies, was to test the applicability of a functional approach in investigating social competence of children in need of special support within the preschool context. The main theoretical framework was systems theory. Study I and II investigated preschool teachers' definitions of children in need of special support and social competence respectively. Study III was a prevalence study investigating the number of children in need of special support based on traditional disability categories and functional difficulties. In study IV the social competence of children perceived to be in need of special support based on traditional categories and functional difficulties was compared using an observational method. The results in study I showed that teachers adopt either a child perspective or an organizational perspective in defining children in need of special support. The child perspective was related to a greater number of children in need of special support in the preschools, indicating that in preschools with several children in need of special support, teachers are more prone on seeing the needs of individual children, as opposed to the needs of the organisation. Study II found that teachers define social competence in young children in terms of intrapersonal skills, or as interpersonal relations. Study III found that the majority of children in need of special support are undiagnosed children with functional difficulties related to speech- and language and peer interaction. Study IV found similar profiles of social competence between diagnosed children and undiagnosed children perceived to be in need of special support. Overall, the results yielded support for adopting a functional approach in studying the social competence of children in need of special support.

AIM: To describe the associations between positive and negative reactions of
informal caregivers of people with dementia and health outcomes across eight
European Countries.
BACKGROUND: Caring for someone with dementia may have implications for the
caregiver's own health and for the care recipient. These consequences could be
associated with caregivers' reactions to the process of care.
DESIGN: Association study based on cross-sectional data.
METHODS: Participants were people with dementia and their informal caregivers
living at home or in long-term care institutions. Data were collected between
November 2010-April 2012 using the Caregiver Reaction Assessment (with dimensions
of self-esteem, lack of family support, financial problems, disrupted schedule
and health problems) and associations were sought with informal caregiver burden,
quality of life and psychological well-being and with dementia sufferers'
neuropsychiatric symptoms, comorbidity and dependency in activities of daily
living using correlation coefficients.
RESULTS: Data from 2014 participants were used. Variability across countries was
noted, as well as differences between care at home and in long-term care
institutions. In general, self-esteem and lack of family support correlated with
caregiver burden and psychological well-being. Associations were also found
between disrupted schedule and caregiver burden, psychological well-being and
quality of life. Health problems were clearly associated with caregiver burden,
psychological well-being and quality of life.
CONCLUSION: Study results support links between the reactions of informal
caregivers of people with dementia and health outcomes. These may have
implications in terms of how services are addressed.

OBJECTIVE:
To examine associations between health risk behaviours and suicidal ideation and attempts in Canadian adolescents aged 12 to 13 years. Young adolescents think about and attempt suicide. However, most existing research on suicide has been conducted on individuals aged 15 years and older.
METHOD:
The present study examined a nationally representative Canadian sample of adolescents aged 12 to 13 years (n=2090). Health risk behaviours included disruptive (shoplifting, physical fighting, damaging property, fighting with a weapon, carrying a knife, and gambling), sexual (petting below the waist and sexual intercourse), and substance use behaviours (smoking cigarettes, consuming alcohol, marijuana or hash, and glue or solvents). Unadjusted and adjusted (for all significant health risk behaviour and psychiatric symptoms) models were tested.
RESULTS:
All health risk behaviours were common among male and female adolescents. In unadjusted models, almost all health risk behaviours were associated with suicidal ideation and attempts among adolescent boys. In adjusted models, only damaging property, sexual intercourse, and smoking cigarettes remained statistically associated with suicidal ideation, while smoking cigarettes and using marijuana or hash remained statistically associated with suicide attempts among adolescent boys. All health risk behaviours were statistically associated with suicidal ideation and attempts among female adolescents in unadjusted models. In adjusted models, only carrying a knife remained statistically associated with suicidal ideation, while shoplifting and gambling remained statistically associated with suicide attempts among adolescent girls.
CONCLUSIONS:
Health risk behaviours among young adolescents are associated with suicidal ideation and attempts among young adolescents. Recognizing health risk behaviours among young adolescents may be one means of understanding who among them is at increased risk of suicidality.

Abstract
OBJECTIVE:
To evaluate the 3 alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) as a brief screening test for heavy drinking and/or active alcohol abuse or dependence.
METHODS:
Patients from 3 Veterans Affairs general medical clinics were mailed questionnaires. A random, weighted sample of Health History Questionnaire respondents, who had 5 or more drinks over the past year, were eligible for telephone interviews (N = 447). Heavy drinkers were oversampled 2:1. Patients were excluded if they could not be contacted by telephone, were too ill for interviews, or were female (n = 54). Areas under receiver operating characteristic curves (AUROCs) were used to compare mailed alcohol screening questionnaires (AUDIT-C and full AUDIT) with 3 comparison standards based on telephone interviews: (1) past year heavy drinking (>14 drinks/week or > or =5 drinks/ occasion); (2) active alcohol abuse or dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either.
RESULTS:
Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881).
CONCLUSIONS:
Three questions about alcohol consumption (AUDIT-C) appear to be a practical, valid primary care screening test for heavy drinking and/or active alcohol abuse or dependence.

We conducted a pragmatic, mixed methods study comparing rural family caregivers
receiving e-health caregiver support (n = 35) with a control group (n = 21)
receiving conventional, non-e-health, caregiver support. After 18 months, the
benefits of support were evaluated using the Care Effectiveness Scale (40-items
exploring the domains of preparedness, enrichment and predictability). In all
domains the e-health group scored significantly higher than the control group.
The adjusted difference for overall benefits was 3.0 (P = 0.02) on the scale
0-10. In addition, semi structured interviews were conducted with a sub-sample of
the caregivers. For the e-health group flexibility, availability and being able
to individualise the support were essential factors. All caregivers in the
control group found conventional support to be beneficial, but also stressed
unmet needs related to the conventional support being standardised and
non-flexible. The study suggests that providers of caregiver support should offer
e-health support as an alternative to conventional caregiver support, as it can
be more beneficial to family caregivers.

This is an introductory report for the Brief Symptom Inventory (BSI), a brief psychological self-report symptom scale. The BSI was developed from its longer parent instrument, the SCL-90-R, and psychometric evaluation reveals it to be an acceptable short alternative to the complete scale. Both test--retest and internal consistency reliabilities are shown to be very good for the primary symptom dimensions of the BSI, and its correlations with the comparable dimensions of the SCL-90-R are quite high. In terms of validation, high convergence between BSI scales and like dimensions of the MMPI provide good evidence of convergent validity, and factor analytic studies of the internal structure of the scale contribute evidence of construct validity. Several criterion-oriented validity studies have also been completed with this instrument.

Atherothrombosis is a potentially life-threatening generalised disease process that affects the coronary, cerebral and peripheral vasculature, with clinical manifestations including myocardial infarction, ischaemic stroke and peripheral arterial disease. Atherothrombosis represents a massive clinical and economic burden to healthcare, annually accounting for at least 22% of all deaths globally. Moreover, the prevalence of atherothrombotic disease is increasing as a result of increased longevity resulting in a larger cohort of older individuals. Stroke in particular is a major burden, and is the primary cause of adult disability, the second most important cause of dementia, and the third leading cause of death in industrialised countries. Atherothrombosis is also associated with a poor prognosis, significantly reducing life expectancy in the 60-year-old patient by 8–12 years depending on the vascular event. Moreover, this already shortened life expectancy is further and substantially reduced in patients with more than one atherothrombotic event. The economic burden of atherothrombosis is significant, particularly given its increasing prevalence, with the United States spending over US$300 billion on it. There is thus a need for effective intervention to prevent or reduce mortality and morbidity. Evidence-based medicine using economics, clinical trials data, outcomes research, epidemiology and risk stratification are necessary to target treatment effectively to patients at greatest risk, in an attempt to reduce the burden of atherothrombotic disease.

In recent years in Italy, population ageing, rising female labour-market participation, and the restructuring of the welfare state have combined to create increased demand for long-term care services for frail and dependent older people. The rising demand has increasingly been met by immigrant women of different nationalities, and to a lesser extent immigrant men, who are hired to provide individualised care in people's own homes and other private settings. While there have been many studies of this growing phenomenon, very little attention has been paid to the reasons that bring family care-givers to choose this care-support option. To begin to fill the gap, this paper reports the finding of a qualitative study of 26 family members who were caring for a disabled elder. Semi-structured interviews lasting between 60 and 100 minutes and that covered various aspects of long-term care in family households were conducted. The participants' responses indicate that they did not choose immigrant home eldercare assistants solely for economic reasons but also to be consistent with cultural, moral and traditional understandings of family responsibilities and care. They also provide valuable findings and insights into Italian attitudes towards the welfare state and the care-labour market. While the wealthiest respondent declared a clear predilection for the free-market and a desire to bypass the state, the majority of the respondents advocated a stronger role of the welfare state in helping people cope with the increased burden of long-term care.

In recent years in Italy, population ageing, rising female labour-market partici-pation, and the restructuring of the welfare state have combined to create in-creased demand for long-term care services for frail and dependent older people.The rising demand has increasingly been met by immigrant women of differentnationalities, and to a lesser extent immigrant men, who are hired to provideindividualised care in people's own homes and other private settings. While therehave been many studies of this growing phenomenon, very little attention hasbeen paid to the reasons that bring family care-givers to choose this care-supportoption. To begin to fill the gap, this paper reports the finding of a qualitative studyof 26 family members who were caring for a disabled elder. Semi-structuredinterviews lasting between 60 and 100 minutes and that covered various aspects of long-term care in family households were conducted. The participants' responsesindicate that they did not choose immigrant home eldercare assistants solely foreconomic reasons but also to be consistent with cultural, moral and traditionalunderstandings of family responsibilities and care. They also provide valuablefindings and insights into Italian attitudes towards the welfare state and the care-labour market. While the wealthiest respondent declared a clear predilection forthe free-market and a desire to bypass the state, the majority of the respondentsadvocated a stronger role of the welfare state in helping people cope with theincreased burden of long-term care.

This article summarizes the development of the caregiver-provider relationship assessment (CPRA) designed to measure family caregivers' perceptions of relationship quality with health care providers. Using an online sample of family caregivers (n = 156), the patient reactions assessment (PRA) was adapted for use with family caregivers and subjected to principal component and reliability analyses. Analyses indicate that the CPRA factor structure is analogous to the original PRA scale, and Cronbach's BFGR181|END for the three CPRA subscales range from .85 to .91. The tool can be used by clinicians and researchers in efforts to help family caregivers become more effective communicators in health care contexts.

Abstract
BACKGROUND: Dementia presents barriers to the collaboration between individuals and the healthcare system. Caregivers perform multiple functions helping patients with basic and instrumental activities but also communicating and mediating the dyads' needs within the broader social group. Interventions focusing on caregivers show that caregiver burden can be reduced, improving patient outcomes in a cost-effective way, but the generalisation of these findings is limited by several factors such as low participation rates of caregivers in studies. There is a global push to increase patient participation in health care, but this can be difficult for patients with dementia. Caregiver participation has arisen as a substitute, but there is a lack of standardised definitions, goals and outcome measurement tools for this participation. METHODS: In 2015, the Swedish Association of Local Authorities and Regions commissioned a study on possibilities of increasing caregiver participation within the Swedish Dementia Registry (SveDem). This discussion paper updates and adapts that report, aiming to broadly summarise the caregiving phenomenon in order to provide a backdrop for clinicians seeking to understand the legal, ethical and practical considerations of caregiver participation in dementia. Relevant literature on caregiver participation is presented, and its definition, extent and practical implementation are discussed. DISCUSSION: The Swedish legal framework compels care providers to facilitate patient and caregiver participation in dementia and provides support to caregivers through the local level of government, but further work is needed to clarify and define the extension and form that this participation must take in clinical practice. Advanced directives are one step in extending patient participation to the period of advanced dementia. CONCLUSION: Little research exists on caregiver participation. There is a need to develop a framework for caregiver and patient participation to determine the extent, type and form that such participation should take in health care, research and quality initiatives pertaining to persons with dementia

The 30-item Children of Alcoholics Screening Test (CAST) is shortened to a 6-item scale (CAST-6) using Principal Components Analysis of CAST responses for three distinct samples: outpatient substance abusers, outpatient psychiatric patients, and medical students. The face validity, internal consistency, and discriminatory ability of the CAST-6 are examined. The CAST-6 is judged to compare favorably with the full CAST and to provide a more efficient way to identify adult children of alcoholics.

Children of alcoholics are commonly pictured as destined to become alcoholics themselves and to develop psychological problems. Research on children of alcoholics, however, has not strongly supported this impression. Rather, there is good reason to believe that children of alcoholics develop a checkerboard of strengths and weaknesses. Although the weaknesses are adequately explained by a traditional risk paradigm that we have called the damage model, the strengths are overlooked. The challenge model and its related vocabulary of strengths extends the damage model by including the possibility that children of alcoholics and other children of hardship can be resilient as well as vulnerable. The model offers a developmental vocabulary of resilience. The challenge model implies that psychiatrists should not launch exclusively a search for pathology in children of alcoholics, but should ask questions of patients more along the line of 'How is your struggle going?'

PURPOSE/OBJECTIVES: To describe children's worries when their mothers are newly diagnosed with early-stage breast cancer. DESIGN: Descriptive, qualitative study. SETTING: Private family homes. SAMPLE: Case intensive interviews with 16 children who ranged in age from 11-18 years at the time that interviews were conducted and who had been 8-12 years of age when their mothers were diagnosed with early-stage breast cancer. METHODS: Semistructured interviews with the children were audiorecorded, transcribed, and inductively coded into categories of distinct worries about their mothers' breast cancer. MAIN RESEARCH VARIABLES: Children's descriptions of their worries and confusion resulting from their mothers' breast cancer diagnoses. FINDINGS: The children voiced nine categories of worry during the interviews: worrying that the mother was going to die; feeling confused; worrying that something bad would happen; worrying about the family and others; worrying when the mother did not look good; worrying that their mothers would change; wondering if the family would have to cut back financially; worrying about talking to others; and wondering if they, the children, would get cancer. CONCLUSIONS: Children of mothers with breast cancer experience multiple worries concerning their mothers, their families, and themselves. The data revealed that they attempted to make sense of their mothers' illness for themselves and imagined how it might affect their own lives in the future.IMPLICATIONS FOR NURSING PRACTICE: Programs and materials need to be developed that help parents address the multiple worries that children whose mothers have early-stage breast cancer experience.

For years we have been treating numerous concentration camp survivors in the psychiatric clinics and hospitals of Israel. In recent years we have been seeing increasing numbers of the second generation suffering from a wide spectrum of emotional disorders, personality disturbances, borderline and psychotic states which are clearly related to the long-term effects of massive traumatization in the survivor parents. These effects are manifest in four inter-related areas of disturbance within the family—the parents' mental state, the family atmosphere, inter-personal functioning in the family and specific distortions in the parent-child interaction. Excessive talking about holocaust experiences to children, or the opposite —lack of communication, avoidance and denial of these experiences—are patterns frequently found in the children of survivors who seem to be most affected by the massive traumatization of the parents. It is postulated that therapy of the survivor parents can modify the transmissions of affects to the children. Family therapy is indicated whenever possible.

Pediatric practices are faced with a growing demand that they address the
healthy development of their patients. As pediatric practices strengthen their role as medical
homes for their patients, they need either to provide expanded services or enhance their
capacity to coordinate that care. One option for enhancing the existing capacity of pediatric
practices is colocation with other providers and services in the same setting. This issue
brief examines what is currently known about the use of colocation and its benefits. The
literature and interviews used as information resources for the brief suggest that colocation
of services is not a single strategy but rather a complex set of relationships, organizational
structures, and other features meant to help practices deliver effective care. However, more
thorough examination of current colocation approaches is needed before advice can be
provided to practices considering this option.

Fourteen children with significant depressive symptoms from an open clinical trial of Primary and Secondary Control Enhancement Training augmented with Caregiver–Child Relationship Enhancement Training, participated in a 2- to 3-year follow-up assessment. The results suggested that the significant decreases in depressive symptoms observed at posttreatment were maintained at 2- to 3-year follow-up. Mothers' reports of significant improvement of child psychosocial functioning were also maintained, providing social validation of the effects. Pretreatment child-rated mother-child relations predicted depressive symptoms at 2- to 3-year follow-up. These long-term data support the use of the combined intervention and suggest the need for further research on caregiver involvement in treatment. (PsycINFO Database Record (c) 2013 APA, all rights reserved)(journal abstract)

Combined Individual Cognitive Behavior Therapy ang Parent Training for Childhood Depression: 2-to 3-year Follow Up.

As populations around the world age, increasing efforts are required from families and governments to secure care and support for older and disabled people. Furthermore, both women and men are expected to work later into life. Taken together, these two facts have made the relationship between work and care a burning issue for social and employment policy as well as for those working toward economic sustainability. Emphasizing the lessons that can be learned from individual experiences, this book widens current debates on these topics, bringing the experiences of individuals who support older, disabled, or chronically ill partners, relatives, or children to the discussion table.

The child's interactions with persons in the proximal environment constitute the context for development of communication. Within early close relationships, the child acquires communication skills; developmental outcomes are defined by the continuous dynamic interactions of the child, the experiences provided by the family and close environment, and the use of different means of augmentative and alternative communication (AAC). Communication problems manifest in a variety of ways and at different levels of severity. The nature of problems differs as a function of the child's age and diagnosed condition, the communication skills of interaction partners, and the availability of communication aids. The focus for assessment and intervention may be the child, the family, the close environment and/or the interactions between them. Clarifying these varied functions and environmental factors is crucial for appropriate assessment and provision of augmentative and alternative communication (AAC) interventions. This paper reviews issues in assessment and intervention for children in need of AAC and presents the World Health Organizations' (WHO) International Classification of Functioning, Disability and Health version for Children and Youth (ICF-CY) as a tool to enhance assessment and intervention in the AAC field.

In the present study, the communicative spontaneity of 23 children with high support needs who used Augmentative and Alternative Communication (AAC) in a classroom setting was evaluated. In contrast to previous research, spontaneity was evaluated on a continuum rather than being treated as a binary variable. Spontaneity was found to be highly variable, but some students clearly lacked the range of spontaneity that would be associated with fully functional communication. Aided AAC systems were notably less spontaneous than signing or nonsymbolic communication. There was also evidence of systematic variation in spontaneity across pragmatic function, with instrumental functions being more spontaneous than commenting. The results of the present study highlight the need to consider spontaneity when assessing individuals who use AAC systems.

Abstract
OBJECTIVE:
To evaluate community-provided trauma-focused cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)-related posttraumatic stress disorder (PTSD) symptoms.
DESIGN:
Randomized controlled trial conducted using blinded evaluators.
SETTING:
Recruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009.
PARTICIPANTS:
Of 140 consecutively referred 7- to 14-year-old children, 124 participated.
INTERVENTIONS:
Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy).
MAIN OUTCOME MEASURES:
Total child PTSD symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Children's Depression Inventory (depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems).
RESULTS:
Intent-to-treat analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings. The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ(2) = 4.67, P = .03) and had significantly fewer serious adverse events.
CONCLUSIONS:
Community TF-CBT effectively improves children's IPV-related PTSD and anxiety.

Objective To evaluate community-provided trauma-focused cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)–related posttraumatic stress disorder (PTSD) symptoms.

Design Randomized controlled trial conducted using blinded evaluators.

Setting Recruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009.

Participants Of 140 consecutively referred 7- to 14-year-old children, 124 participated.

Interventions Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy).

Main Outcome Measures Total child PTSD symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Children's Depression Inventory (depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems).

Results Intent-to-treat analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings. The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ2 = 4.67, P = .03) and had significantly fewer serious adverse events.

Conclusions Community TF-CBT effectively improves children's IPV-related PTSD and anxiety.

Objective To evaluate community-provided trauma-focused cognitive behavior therapy (TF-CBT) compared with usual community treatment for children with intimate partner violence (IPV)–related posttraumatic stress disorder (PTSD) symptoms.

Design Randomized controlled trial conducted using blinded evaluators.

Setting Recruitment, screening, and treatment were conducted at a community IPV center between September 1, 2004, and June 30, 2009.

Participants Of 140 consecutively referred 7- to 14-year-old children, 124 participated.

Interventions Children and mothers were randomly assigned to receive 8 sessions of TF-CBT or usual care (child-centered therapy).

Main Outcome Measures Total child PTSD symptoms assessed using child and parent structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime Version [K-SADS-PL]) and self-report (University of California at Los Angeles PTSD Reaction Index [RI]). Secondary child outcomes were scores on the K-SADS-PL (PTSD symptom clusters), Screen for Child Anxiety Related Emotional Disorders (SCARED) (anxiety), Children's Depression Inventory (depression), Kaufman Brief Intelligence Test (cognitive functioning), and Child Behavior Checklist (total behavior problems).

Results Intent-to-treat analysis using last observation carried forward showed superior outcomes for TF-CBT on the total K-SADS-PL (mean difference, 1.63; 95% confidence interval [CI], 0.44-2.82), RI (mean difference, 5.5; 95% CI, 1.37-9.63), K-SADS-PL hyperarousal (mean difference, 0.71; 95% CI, 0.22-1.20), K-SADS-PL avoidance (0.55; 0.07-1.03), and SCARED (mean difference, 5.13; 95% CI, 1.31-8.96). Multiple imputation analyses confirmed most of these findings. The TF-CBT completers experienced significantly greater PTSD diagnostic remission (χ2 = 4.67, P = .03) and had significantly fewer serious adverse events.

Conclusions Community TF-CBT effectively improves children's IPV-related PTSD and anxiety.

Community-based rehabilitation (CBR) recognizes that in the secure, loving environment of his/her own home, the person with a brain injury and the family, provided with support and guidance, can effectively augment or supersede hospital-based rehabilitation. This paper will explore the methods used to establish a rehabilitation programme in the home, the initial moves, the family dynamics, the advantages, and some of the programmes required for the restoration of function of sensory, cognitive and motor abilities. The mobilization of the therapy workforce, including the use of extended family and trained volunteers from the community, is explained. The importance of volunteer meetings and the continuing education of the family and volunteers is emphasized. Respite care for the family and the aim of returning the family towards normality is considered. The enormous cost/benefit of the community-based rehabilitation is detailed, and comparative costs between this method and hospital-based rehabilitation are provided

Aim: Family burden is prevalent in psychotic disorders, but little is known about burden experienced by families of patients in early illness. In this exploratory study, we examined the extent of burden reported by families of patients during a putative prodromal period and in the aftermath of psychosis onset. Methods: Family burden was assessed in 23 family members of patients with emerging or early psychosis. The Family Experiences Interview Schedule was used to assess both objective and subjective burden. Objective burden is comprised of increased resource demands and disruption of routine. Subjective burden includes worry, anger/displeasure and resentment at objective burden. Results: Family burden was comparable for the clinical high-risk and recent-onset psychosis patients. Worry was as high as previously reported for more chronic patients. By contrast, there was a relative absence of displeasure/anger. Family members endorsed assisting patients in activities of daily living, although not 'minding' doing so, and reported little need to supervise or control patients' behaviour. Conclusions: Early in emerging psychotic illness, families report helping patients and worrying about them, but their lives are not yet disrupted and they do not have much anger or resentment. This may be an ideal time then for intervention with families, as worry may motivate help-seeking by families. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)

Smaller social networks are associated with poorer health and well-being, especially as people negotiate life transitions. Many older adults, however, tend to have smaller networks, without the expected negative outcomes. To understand better how older adults avoid such outcomes we measured social network management skills, attachment style, and depression among individuals going through a life transition. Older adults who recently became caregivers were compared with young adults who recently transitioned to college. Although older adults initiated fewer and terminated more social ties (being selective in their choice of network members), both age groups had an equal number of close network members. A closer look revealed that securely attached older adults maintained their social ties, and in turn, sustained low levels of depression. These findings emphasize the importance of attachment style and network skills to mental health in general, and among older adults specifically

Using an alternating treatment design, the acquisition, generalization, and maintenance of 8 tasks consisting of 2 communication functions (mand vs tact), 2 communication modes (receptive vs expressive), and 2 communicative symbols (gesture vs picture) were compared in 4 adolescents with profound intellectual disabilities and no receptive or expressive language. All Ss acquired 6 of the 8 tasks; the tasks not acquired were those in the receptive mode of manding, using either gestures or pictures. For all Ss, within the 6 tasks acquired, the tact function in the receptive mode using pictures was the most rapidly obtained and the most easily generalized and maintained, while the tact function in the expressive mode using gestures was the most slowly acquired and the most difficult to generalize and maintain. The communication function of manding was more easily acquired, generalized, and maintained than was tacting in the expressive mode for both types of symbols for all Ss. For the tact function, both types of symbols were acquired, generalized, and maintained better in the receptive mode than the expressive mode for all subjects. Also, for all Ss, pictures were more easily acquired, generalized and maintained than gestures. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Objective

Deficits in executive functioning, including working memory (WM) deficits, have been suggested to be important in attention-deficit/hyperactivity disorder (ADHD). During 2002 to 2003, the authors conducted a multicenter, randomized, controlled, double-blind trial to investigate the effect of improving WM by computerized, systematic practice of WM tasks.

Method

Included in the trial were 53 children with ADHD (9 girls; 15 of 53 inattentive subtype), aged 7 to 12 years, without stimulant medication. The compliance criterion (>20 days of training) was met by 44 subjects, 42 of whom were also evaluated at follow-up 3 months later. Participants were randomly assigned to use either the treatment computer program for training WM or a comparison program. The main outcome measure was the span-board task, a visuospatial WM task that was not part of the training program.

Results

For the span-board task, there was a significant treatment effect both post-intervention and at follow-up. In addition, there were significant effects for secondary outcome tasks measuring verbal WM, response inhibition, and complex reasoning. Parent ratings showed significant reduction in symptoms of inattention and hyperactivity/impulsivity, both post-intervention and at follow-up.

Conclusions

This study shows that WM can be improved by training in children with ADHD. This training also improved response inhibition and reasoning and resulted in a reduction of the parent-rated inattentive symptoms of ADHD.

Purpose: To identify differences in perspectives that may complicate the process of joint decision making at the end of life, this study determined the agreement of family and staff perspectives about end-of-life experiences in nursing homes and residential care/assisted living communities and whether family and staff roles, involvement in care, and interaction are associated with such agreement. Design and Methods: This cross-sectional study examined agreement in 336 family-staff pairs of postdeath telephone interviews conducted as part of the Collaborative Studies of Long-Term Care. Eligible deaths occurred in or within 3 days of leaving one of a stratified random sample of 113 long-term care facilities in four states and after the resident had lived in the facility 15 days of the last month of life. McNemar p values and kappas were determined for each concordance variable, and mixed logistic models were run. Results: Chance-adjusted family-staff agreement was poor for expectation of death within weeks (66.9% agreement, k = .33), course of illness (62.9%, 0.18), symptom burden (59.6%, 0.18), and familiarity with resident's physician (59.2%, 0.05). Staff were more likely than family to expect death (70.2% vs 51.5%, p /BFM1XC8|END .001) and less likely to report low symptom burden (39.6% vs 46.6%, p = .07). Staff involvement in care related to concordance and perspectives of adult children were more similar to those of staff than were other types of family members. Implications: Family and staff perspectives about end-of-life experiences may differ substantially; efforts can be made to improve family-staff communication and interaction for joint decision making.

The overall aim of this thesis was to describe and analyse how the involvement of relatives is conditioned in nursing homes from different critical perspectives. Gender perspectives, discourse analysis and intersectional theory are applied, based on social constructionist ontology. The thesis comprises three qualitative papers and data are based on ethnographically-focused fieldwork in three municipal nursing homes in the form of formal/informal interviews, participating observations and the analysis of documents.

Based on gender perspectives, the routines and reasonings among nursing staff were studied and thematically analysed in relation to how these conditioned the involvement of relatives in the daily caring activities (I). In the second study (II), the nursing staff were interviewed in groups to describe, discursively analyse and identify the biopolitical meaning in the "involvement discourse" that was collectively constructed in the speech of the nursing staff concerning the involvement of relatives. In the last study (III), interviews with relatives were thematically analysed in the context of intersectional theory about their involvement in the nursing homes.

The findings show that the conditions for relatives' involvement were dynamic and constantly in re-negotiation, but also conservative and inflexible. This placed relatives in both privileged and unprivileged social positions in the nursing homes, which were relevant for their involvement. The relatives were considered to be "visitors", which conditioned the characteristics and levels of involvement in the care of the residents and was linked to gendered notions of the division of labor, both within the groups of relatives and between nursing staff and relatives (I). The involvement of relatives was conditioned by the biopolitics of an "involvement discourse" that prevailed in the nursing homes. This built upon family-oriented rhetorics and metaphors that upheld and legitimised notions about relatives. The relatives were considered to be members of the "old" family in relation to the "new" family represented by the nursing staff (II). The relatives described how they were positioned in a betweenship, squeezed between different competing social musts from the older family members, the nursing homes as institutions and the nursing staff (III).

Inverting the prevailing picture of the involvement of relatives would make it possible to consider the nursing staff as pedagogical, professional and caring "visitors" in the nursing homes for the benefit of the residents and their relatives. This could be achieved through a constructive change management which emphasises the learning of nursing staff, their responsibility and the emotions of relatives, along with a focus on alternative notions of involvement, where relatives are included in the development of quality of care in Swedish nursing homes.

Clinical experience and research findings suggest that approaches to treatment that concomitantly increase the intensity of affective bonds and repair the inevitable disruptions of those bonds are the sine qua non of all effective psychotherapy. It is suggested here that this is especially true for substance abusers. It is further suggested that group psychotherapy can be an especially effective medium for providing the delivery of this crucial element of therapy if the proper paradigm for guiding treatment application is adapted. Attachment theory furnishes an especially effective theoretical formula for informing the way that group therapy should be applied if the full potential of treatment is to be maximized with substance abusers.

Clinical experience and research findings suggest that approaches to treatment that concomitantly increase the intensity of affective bonds and repair the inevitable disruptions of those bonds are the sine qua non of all effective psychotherapy. It is suggested here that this is especially true for substance abusers. It is further suggested that group psychotherapy can be an especially effective medium for providing the delivery of this crucial element of therapy if the proper paradigm for guiding treatment application is adapted. Attachment theory furnishes an especially effective theoretical formula for informing the way that group therapy should be applied if the full potential of treatment is to be maximized with substance abusers.

Clinical experience and research findings suggest that approaches to treatment that concomitantly increase the intensity of affective bonds and repair the inevitable disruptions of those bonds are the sine qua non of all effective psychotherapy. It is suggested here that this is especially true for substance abusers. It is further suggested that group psychotherapy can be an especially effective medium for providing the delivery of this crucial element of therapy if the proper paradigm for guiding treatment application is adapted. Attachment theory furnishes an especially effective theoretical formula for informing the way that group therapy should be applied if the full potential of treatment is to be maximized with substance abusers.

This article examines how girls manage challenging encounters with non-familial adults. Drawing on a subset of qualitative data collected as part of a larger ethnographic study, it examines the ways girls maintain a strong sense of self as a good person in the face of interpersonal challenge from these non-familial adults. The discourse of the 'good girl' allows them to resist excessive demands of adults and provides opportunities to have fun. The importance of the parent—child relationship in terms of providing a safe context from which the girls can generate the good and bad girl facades is also highlighted.

Connecting Children focuses on children's understandings of care and their views of different family lives. It portrays the lives of children aged 11-12 and shows how families connect children in different ways both in the household but also in their wider kinship networks. The children studied reflect upon family life and especially upon situations where their own family lives change dramatically, such as when parents divorce or are unable to care for them.
This book will be of interest to those working in education, social work, child care, counselling, social policy and childhood studies.

Family members and significant others provide significant proportions of unpaid care for people experiencing a mental illness. Although the carer role is pivotal to contemporary mental health service delivery, the role of carers and the issues they face have received only scant attention in the literature. This paper presents the second part of the findings of an exploratory, qualitative inquiry, which sought greater understanding of carers' experiences of, and attitudes to opportunities for participation in care and treatment at an individual or systemic level, with particular emphasis on the role of psychiatric nurses in encouraging or discouraging participation. This paper explores the theme of systemic barriers to participation. These findings demonstrate the variable experiences of carers in their opportunities to participate and the important role nurses can assume in supporting carers' increased participation in the mental health care for their relative or significant other.

BACKGROUND:
Previous studies have demonstrated greatly increased risks of severe psychiatric morbidity for former child welfare clients. We investigated psychotropic medication in this population as a proxy indicator of less severe mental health problems.
METHODS:
This register-based cohort study comprises the Swedish birth cohorts between 1973 and 1981, 765,038, including 16,986 former children from societal care and 1296 national adoptees. Estimates of risk of retrieval of prescribed psychotropic medications during 2009 were calculated in four categories (any such drug, neuroleptics, antidepressants and anxiolytics/hypnotics) as hazard ratios (HRs) with 95% confidence intervals (CIs) using Cox regression analysis, adjusting for birth parental background including psychiatric morbidity.
RESULTS:
17-25% of men and 25-32% of the women with childhood experiences of societal care retrieved at least one prescription of a psychotropic drug, equivalent to age-adjusted HRs of between 2.1 and 3.3, compared with the general population. Adjusting the analysis for birth parental confounders attenuated risks to between 1.5 and 2.7, depending on subgroup and sex. Men-especially those that entered care settings during their teens-tended to have higher risks of all outcomes. Adjusted HRs for national adoptees were similar to former children in care.
CONCLUSIONS:
Former residents of societal care are a high-risk group for mental health problems well into mature adult age, demonstrating the need for systematic screening and implementation of effective prevention/treatment during time in care.

BACKGROUND:
Previous studies have demonstrated greatly increased risks of severe psychiatric morbidity for former child welfare clients. We investigated psychotropic medication in this population as a proxy indicator of less severe mental health problems.
METHODS:
This register-based cohort study comprises the Swedish birth cohorts between 1973 and 1981, 765,038, including 16,986 former children from societal care and 1296 national adoptees. Estimates of risk of retrieval of prescribed psychotropic medications during 2009 were calculated in four categories (any such drug, neuroleptics, antidepressants and anxiolytics/hypnotics) as hazard ratios (HRs) with 95% confidence intervals (CIs) using Cox regression analysis, adjusting for birth parental background including psychiatric morbidity.
RESULTS:
17-25% of men and 25-32% of the women with childhood experiences of societal care retrieved at least one prescription of a psychotropic drug, equivalent to age-adjusted HRs of between 2.1 and 3.3, compared with the general population. Adjusting the analysis for birth parental confounders attenuated risks to between 1.5 and 2.7, depending on subgroup and sex. Men-especially those that entered care settings during their teens-tended to have higher risks of all outcomes. Adjusted HRs for national adoptees were similar to former children in care.
CONCLUSIONS:
Former residents of societal care are a high-risk group for mental health problems well into mature adult age, demonstrating the need for systematic screening and implementation of effective prevention/treatment during time in care.

Encounters and relationships are basic foundations of nursing care and the preconditions for these foundations are changing along with a change in healthcare towards an increase of home-based care. In this development the use of distance-spanning technology is becoming increasingly common. There is a need to develop more knowledge and a theory base about the role of the encounter and the relationship in home-based care. Most studies so far cover the topic in the context of hospital care. There is also need to develop more knowledge of experiences of distance-spanning technology in home-based care. The overall aim of this doctoral thesis was to explore home-based care with specific focus on the use of distance-spanning technology, encounters and relationships from the perspectives of persons in need of care, general practitioners (GPs) and registered nurses (RNs).
The thesis contains studies with persons in need of home-based care (n=9), general practitioners (n=17) and registered nurses (n=24). The study with RNs consisted of registered nurses (n=13) and district nurses (n=11). The data was collected through individual interviews and group interviews and were analyzed by qualitative content analysis with various degrees of interpretations.
Home-based care with mobile distance-spanning technology (MDST) was experienced as positive and it opens up possibilities, however MDST also has limitations. It was considered that MDST should be used by care professionals and not by the person in need of care or their family members. The MDST affects home-based care and the work and cooperation in home-based care. The expression was that a face-to-face encounter should be the norm and MDST cannot replace all face-to-face encounters in home-based care. MDST could work in some situation, but should be used with caution. The findings also show that good encounters in home-based nursing care contain dimensions of being personal and professional, and that the challenge is to create a good balance between these. Being together in the encounter is a prerequisite for the development of relationships and good nursing care at home is built on a trusting relationship. The relationship is a reciprocal relationship that the person and the nurse develop together and nurses have to consciously work on the relationship. It seems that a good encounter and a trusting relationship could affect the views on the use of distance-spanning technology in homebased care. The participants in the studies in general expressed positive attitude towards distancespanning technology at the same time as they expressed caution about an extensive use of it in home-based care. They highlighted the importance of positive encounters and the importance of the relationship in order to receive and provide good care and nursing care in the homes. The context of home-based care has changed and will continue to change over time. This change leads to that the use of distance-spanning technology is increasing and challenges the nurses to develop work strategies that can promote competence, caring and communication in the encounter, and building and maintaining relationships in home-based nursing care.

Background Psychological interventions for postnatal depression can be beneficial in the short term but their longer-term impact is unknown.

Aims To evaluate the long-term effect on maternal mood of three psychological treatments in relation to routine primary care.

Method Women with post-partum depression (n=193) were assigned randomly to one of four conditions: routine primary care, non-directive counselling, cognitive—behavioural therapy or psychodynamic therapy. They were assessed immediately after the treatment phase (at 4.5 months) and at 9, 18 and 60 months post-partum.

Results Compared with the control, all three treatments had a significant impact at 4.5 months on maternal mood (Edinburgh Postnatal Depression Scale, EPDS). Only psychodynamic therapy produced a rate of reduction in depression (Structured Clinical Interview for DSM—III — R) significantly superior to that of the control. The benefit of treatment was no longer apparent by 9 months post-partum. Treatment did not reduce subsequent episodes of post-partum depression.

Conclusions Psychological intervention for post-partum depression improves maternal mood (EPDS) in the short term. However, this benefit is not superior to spontaneous remission in the long term.

The United Nations Convention on the Rights of the Child (commonly abbreviated as the CRC, CROC, or UNCRC) is a human rights treaty which sets out the civil, political, economic, social, health and cultural rights of children. The Convention defines a child as any human being under the age of eighteen, unless the age of majority is attained earlier under a state's own domestic legislation.

Nations that ratify this convention are bound to it by international law. Compliance is monitored by the UN Committee on the Rights of the Child, which is composed of members from countries around the world. Once a year, the Committee submits a report to the Third Committee of the United Nations General Assembly, which also hears a statement from the CRC Chair, and the Assembly adopts a Resolution on the Rights of the Child.

Governments of countries that have ratified the Convention are required to report to, and appear before, the United Nations Committee on the Rights of the Child periodically to be examined on their progress with regards to the advancement of the implementation of the Convention and the status of child rights in their country. Their reports and the committee's written views and concerns are available on the committee's website.

The UN General Assembly adopted the Convention and opened it for signature on 20 November 1989 (the 30th anniversary of its Declaration of the Rights of the Child). It came into force on 2 September 1990, after it was ratified by the required number of nations. Currently, 196 countries are party to it, including every member of the United Nations except the United States.

Two optional protocols were adopted on 25 May 2000. The First Optional Protocol restricts the involvement of children in military conflicts, and the Second Optional Protocol prohibits the sale of children, child prostitution and child pornography. Both protocols have been ratified by more than 150 states.

A third optional protocol relating to communication of complaints was adopted in December 2011 and opened for signature on 28 February 2012. It came into effect on 14 April 2014.

Background: Conversation partner training can be effective in improving communication in aphasia. However, there is a need for further research about effects of specific training programmes as well as about the relevant characteristics of the conversation partners who are to be candidates for training.

Aims: This pilot study explores the applicability of an adaptation of a conversation partner training programme. In addition, a protocol for assessment of variables relating to the person with aphasia and the conversation partner that may be involved in changes in conversational interaction is examined.

Methods & Procedures: Three dyads with persons with aphasia and their spouses participated in this explorative study with a case-series design. The training outcome was monitored with measures of perceived functional communication and analysis of multiple video-recorded natural conversations obtained at baseline, post intervention, and at a 12-week follow-up. Repeated measures of comprehension, word fluency, and psychological well-being were obtained as well as descriptive measures of the executive function and a profiling of attitudes and behaviour in communication in the spouses.

Outcomes & Results: All three persons with aphasia and two of the spouses reported a slight improvement in the measure of perceived functional communication. This perception of improvement was also reflected in blinded, independent assessments of ability to support communication in conversations for the two spouses who reported improvement. The profiling of the third spouse indicated problems in attitudes to communication and also in aspects of executive function, and may account for the lack of intervention effects seen in the third dyad.

Conclusions: The results show that intervention with the adapted training programme may be effective. It might be argued that the outcome measures as well as other measures fulfil their purpose. The profiling of relevant traits in the conversation partner may be useful, although the prognostic validity of the instruments needs to be further evaluated.

Doktorsavhandling

Abstract [en]
Chronic obstructive pulmonary disease (COPD) is a major public health problem. Symptoms and comorbidities associated with COPD affect the whole body. Clinical guidelines for COPD recommend pulmonary rehabilitation (PR) including exercise training and education promoting self-management strategies. Despite the positive effects on health status, few people with COPD have access to PR. Electronic health (eHealth) has been seen as promising for increased access to evidence-based interventions. To increase the likelihood of a successful implementation, it is important to identity enablers and barriers that might affect implementation outcomes. The aim of this thesis is to explore the experiences, interactions and contexts of the management of COPD in primary care, as well as the design, experienced relevance, effect and expected usefulness of eHealth solutions. The thesis is based on four papers that have used qualitative, quantitative and mixed methods. Qualitative interviews (papers I, II, IV) and focus group discussions (paper IV) were analysed using qualitative content analysis (papers I, IV) and grounded theory (paper II). Quantitative data, collected using questionnaires (paper I) and in a systematic review (paper III) was analysed with descriptive statistics (paper I) and meta-analysis (paper III). The qualitative and quantitative findings in paper I and II were merged in a mixed methods design. Participants in the studies included healthcare professionals (papers I, IV), people with COPD (papers II, III, IV), their relatives (paper IV), senior managers representing primary care centres (paper I), and external researchers (paper IV). The findings in this thesis gave insight in the complex interactions within COPD management between the healthcare organisation (e.g. resources and priority), healthcare professionals (e.g. attitudes, collaboration and competence) and people with COPD (e.g. emotions, attitudes and coping). The healthcare organisation is fragmented with few resources and COPD care takes low priority. The healthcare professionals are Building COPD care on shaky ground (paper I), where the shaky ground is a presentation of the non-compliant organisation and other challenging circumstances. Driven, responsible and ambitious healthcare professionals wish to provide empowering COPD interventions through interprofessional collaboration, but are inhibited by their limited knowledge of and experience with COPD. People with COPD are (Re)acting in an ambiguous interaction with primary care providers (paper II), have limited knowledge and struggle with stigma, while they try to accept and manage their disease. The attitudes and support of healthcare professionals' are essential for necessary interaction and self-management strategies. For people with COPD, this can take different paths: either enhancing confidence with empowering support or coping with disempowering stigma and threat. eHealth solutions such as telehealth, have been used to provide interventions to people with COPD through phone calls, websites or mobile phones, in combination with exercise training and/or education. They show a significant effect on physical activity level, but not on physical capacity and dyspnoea (paper III). Healthcare professionals, people with COPD and their relatives, and external researchers report that, to be useful and relevant in clinical practice, an eHealth tool should be reinforcing existing support structures (paper IV). Furthermore, it needs to fit in the current routines and contexts and create a sense of commitment in its users. According to the participants, information about selfmanagement strategies, such as how-to videos are valuable, and need to help them identify themselves with the people in the videos. The participants regard eHealth as providing knowledge and support for self-management. In conclusion, there is a need for implementation of clinical guidelines for COPD in primary care in order to improve both the management of COPD, as well as the interaction between healthcare professionals and people with COPD. Several actions are needed to facilitate this implementation. The priority and status of COPD management in primary care need to be raised. In addition, more resources (e.g. healthcare professionals) for COPD interventions is required to enhance the conditions for interprofessional collaboration and patient participation. Furthermore, it is important to include physiotherapists in COPD management, considering the focus on exercise training and physical activity. Healthcare professionals in primary care need further training and more time to educate and empower people who have COPD. The use of eHealth may lead to improvements in patient outcomes, although more research on web-based interventions is required. User involvement in the development process of an eHealth tool increases its usefulness and relevance in clinical practice and everyday life. The findings from this thesis may guide implementation processes in primary care, as well as the development of eHealth tools for people with COPD or other long-term conditions.

A majority of us will at some point in our lives take care of family members, relatives and friends in need of assistance. How will this affect us?

Strain related to life satisfaction (LS) and health related quality of life (HRQoL) among caregivers aged 60 years and older has not been previously studied.

Objectives
The main objective was to describe characteristics of non-caregivers (n = 2233) and caregivers (n = 369). Further objectives were to examine differences in HRQoL and LS between caregivers and non-caregivers, and between caregivers stratified by level of strain.

Methods
We analyzed the differences in socio-demographics, social participation, locus of control and symptoms between groups. HRQoL was assessed by Short Form Health Survey (SF-12/PCS and MCS). LS was measured by the Life Satisfaction Index-A (LSI-A).

Results
Caregivers were younger, had more years of formal education, more often cohabiting and relied less on powerful others than non-caregivers. One hundred and thirty-three (36%) caregivers reported high strain. In a three-group comparison including non-caregivers and caregivers stratified for strain, high strain was associated with lower SF12-PCS, SF12-MCS and LSI-A (0.014, <0.001 and <0.001, respectively).

Conclusion
High strain affects caregivers' HRQoL and LS in a negative way.

Practice
It is important for the health care sector to consider the possibility that symptoms in a person acting as a caregiver can be related to high perceived strain.

Implications
A general policy program aiming to identify caregivers and their needs for support is much needed.

Three models of the relations of coping efficacy, coping, and psychological problems of children of divorce were investigated. A structural equation model using cross-sectional data of 356 nine- to twelve-year-old children of divorce yielded results that supported coping efficacy as a mediator of the relations between both active coping and avoiding coping and psychological problems. In a prospective longitudinal model with a subsample of 162 of these children, support was found for Time 2 coping efficacy as a mediator of the relations between Time 1 active coping and Time 2 internalizing of problems. Individual growth curve models over four waves also found support for coping efficacy as a mediator of the relations between active coping and psychological problems. No support was found for alternative models of coping as a mediator of the relations between efficacy and symptoms or for coping efficacy as a moderator of the relations between coping and symptoms.

This brief self-report inventory identifies cognitive and behavioural responses the individual used to cope with a recent problem or stressful situation. The 8 scales include Approach Coping Styles (Logical Analysis, Positive Reappraisal, Seeking Guidance and Support, and Problem Solving) and Avoidant Coping Styles (Cognitive Avoidance, Acceptance or Resignation, Seeking Alternative Rewards, and Emotional Discharge). Information about reliability and validity is presented in the professional manual for each version.

The CRI can be used in in counselling, stress management education, and other settings to identify and monitor coping strategies in adults and adolescents, to develop better clinical case descriptions, and to plan and evaluate the outcome of treatment.

Two separate versions of the CRI have been developed, the CRI-Adult (older than 18 years of age) and the CRI-Youth (ages 12-18 years). Each version has its own manual and an Ideal and an Actual Form. The Ideal Form may be used to compare actual and preferred coping styles, to set treatment goals, and to monitor progress. The Actual Form surveys the individual's actual coping behaviour, whereas the Ideal Form surveys preferred coping styles. Both forms are written at a 6th-grade reading level.

Individuals complete the self-report inventory, marking answers on the answer sheet. The carbonless bottom sheet contains a scoring grid for quick and easy calculation of raw scores. The back page of the answer sheet contains a profile for determining and plotting T-scores and examining patterns of coping. Scoring and profiling take about 5 minutes.

Abstract The Individuals with Disabilities Education Act (IDEA) mandates parent-professional
collaboration. But difficulties between parent and professional collaboration seem to persist.
These difficulties do not seem to be related to a lack of mutual respect or lack of good intentions.
Perhaps difficulties exist because of a lack of common ground. Professionals' thinking is
grounded in theory from personnel preparation and on-the-job experiences. Parents' thinking is
grounded in personal experiences and information from professionals, other parents, technology,
and media. This article describes a mother's and father's experiences over the past 25 years in a
variety of settings as the parents of a child with severe disabilities and as special education professionals.
They present their experiences in special education as parents and provide suggestions
for parents and professionals to develop an effective collaborative relationship

Rapporten är ett resultat av ett forskningsprojekt om elever med flera funktionsnedsättningar i särskolan. Projektet belyser hur egenskaper hos barnet, egenskaper i barnets livsmiljöer samt de omgivande servicesystemen, samverkar och påverkar förutsättningar för barnets utveckling

Eli har en storebror. Det är det många som har förstås. Men inte många har en storebror som Elis. Han är som en gåta tänker Eli ibland. Brorsan. En gåta som inte går att lösa. Ofta oroar sig Eli för brorsan. Men de hör ihop. Brorsan och Eli. Det är bara så. Och inte många har en storebror som Elis. Så det så. 

Eli har en storebror - en berättelse om syskonkärlek.

For many individuals, schizophrenia is a severe and enduring illness. While nurses need to understand the symptomatology of the illness in order to provide specific care and treatment, it also is important to find out how people with schizophrenia embody the illness. Capturing this knowledge will help nurses to provide more appropriate care to these individuals. This paper, which is taken from a larger qualitative study, reports the lived experience of young adults with schizophrenia. Three main themes emerged from the data, which highlighted how these individuals found meaning in schizophrenia. The first theme,"embodied temporality: illness as a catastrophic experience,"portrayed how schizophrenia affected participants' temporality or lived time. The second theme,"embodied relationality: illness as a mediator of social relationships,"reflected how the illness affected their relationships with others. The third theme,"embodied treatment: medications side effects as burdensome,"illustrated how the side effects of antipsychotic medications distorted the individual's perception of his or her body and how it compromised the ability to establish and maintain sexual relationships. The findings are important to mental health nurses because they highlight the need to be sensitive to how people with schizophrenia find meaning in their illness experience and to incorporate this knowledge into the care that they provide.

The systematic review methodology literature refers to the importance of involving stakeholders, including service users & carers, in the research. However, compared with other aspects of the methodology, this aspect of conducting systematic reviews is underdeveloped & the practice of involvement appears highly variable. This article draws on the experience of working with service users & carers in one systematic review to review the barriers to participation & the components of effective involvement. It suggests that quality standards can be identified for service user & carer involvement in systematic reviews, which will benefit policy & practice development. 77 References.

in our discussion of emotion and dysfunction, we have intimated that emotions are instructive about persons because both emotions and the personality are organized around the problem of surviving, getting along, and flourishing over the life course
begin by addressing the question of what an emotion is / describe our own [the authors'] recent work directed at illuminating what we see as one of the important issues in emotion theory—the role of cognitive appraisal
embed this work in a general model of emotion, which identifies the key variables and processes within a systems framework emphasizing person-environment relationships and cognitive mediation
illustrate how emotion theory makes firm contact with a variety of topics currently being pursued across diverse psychological disciplines, especially personality and social psychology
the adaptational problem and the evolution of emotion / appraisal theory / personality, society, and biology in emotion (PsycINFO Database Record (c) 2016 APA, all rights reserved)

In this landmark work, Richard Lazarus -- one of the world's foremost authorities -- offers a comprehensive treatment of the psychology of emotion, its role in adaptation, and the issues that must be addressed to understand it. The work provides a complete theory of emotional processes, explaining how different emotions are elicited and expressed, and how the emotional range of individuals develops over their lifetime. The author's approach puts emotion in a central role as a complex, patterned, organic reaction to both daily events and long-term efforts on the part of the individual to survive, flourish, and achieve. In his view, emotions cannot be divorced from other functions--whether biological, social, or cognitive--and express the intimate, personal meaning of what individuals experience. As coping and adapting processes, they are seen as part of the ongoing effort to monitor changes, stimuli, and stresses arising from the environment. After defining emotion and discussing issues of classification and measurement, Lazarus turns to the topics of motivation, cognition, and causality as key concepts in this theory. Next he looks at individual emotions, both negative and positive, and examines their development in terms of social influences and individual events. Finally, he considers the long-term consequences of emotion on physical health and well-being, and the treatment and prevention of emotional dysfunction. The book draws together the relevant research from a wide variety of sources, and distills the author's pioneering work in the field over the last forty years. As a comprehensive treatment of the emotions, the book will interest students, clinicians, and researchers involved in personality, social and clinical psychology, as well as cognitive and developmental psychology. It may also be used as a supplemental textbook in courses on the psychology of adjustment, emotion, and feeling.

Abstract
Adverse childhood events can influence the development of emotional and physiological self-regulatory abilities, with significant consequences for vulnerability to psychological and physical illness. This study evaluated stress sensitization and inoculation models of the impact of early parental death on stress exposure and reactivity in late adolescence/young adulthood. Ambulatory blood pressure (BP) and diary reports of minor stress were collected every 30 min during waking hours over a 24-hr period from 91 late adolescents/young adults (43 early bereaved, 48 nonbereaved). Across the sample, minor stressors were associated with elevated BP and negative affect. The bereaved group had lower BP than did the nonbereaved group. Within the bereaved group, higher perceived caring from the surviving parent was associated with fewer reports of minor stress and lower stress-related negative affect. Higher perceived parental caring during childhood was associated with lower BP across the sample and more frequent hassles in the nonbereaved group. Findings support both the stress inoculation and sensitization models, suggesting that childhood parental loss and parental caring exert important influences on children's development of stress sensitivity.

Adverse childhood events can influence the development of emotional and physiological self-regulatory abilities, with significant consequences for vulnerability to psychological and physical illness. This study evaluated stress sensitization and inoculation models of the impact of early parental death on stress exposure and reactivity in late adolescence/young adulthood. Ambulatory blood pressure (BP) and diary reports of minor stress were collected every 30 min during waking hours over a 24-hr period from 91 late adolescents/young adults (43 early bereaved, 48 nonbereaved). Across the sample, minor stressors were associated with elevated BP and negative affect. The bereaved group had lower BP than did the nonbereaved group. Within the bereaved group, higher perceived caring from the surviving parent was associated with fewer reports of minor stress and lower stress-related negative affect. Higher perceived parental caring during childhood was associated with lower BP across the sample and more frequent hassles in the nonbereaved group. Findings support both the stress inoculation and sensitization models, suggesting that childhood parental loss and parental caring exert important influences on children's development of stress sensitivity.

The traditional approach to substance-abuse treatment involves the disease model, as promulgated through Alcoholics Anonymous. In this model, the message for relatives and friends of substance users is that their behavior cannot influence the user to either enter treatment or to reduce their substance use. The main emphasis instead is on helping relatives concentrate on their own lives and cultivating a sense of detachment from the drinker. However, a beginning empirical literature has developed on treatment with the relatives of substance users, which indicates that the relative may be able to affect the behavior of the substance user, although the effect of such treatment on the relative may be less consistent. This article will discuss findings of studies, which are organized according to whether relatives are treated alone or in a marital therapy context. Suggestions for further research in this area and implications for social work are discussed.

Under det senaste decenniet har barnfattigdom kommit att bli en alltmer framträdande problematik på den politiska agendan i Sverige. Forskning om barnfattigdom har ofta utgjorts av kartläggningar och statistiska data varför forskning om barns vardagsliv och erfarenheter i relation till ekonomisk utsatthet har efterfrågats såväl nationellt som internationellt. Syftet med avhandlingen har varit att utforska och analysera barns erfarenheter av fattigdom som en del av deras identitetsskapande samt synliggöra hur deras aktörskap kan förstås som en strategi för att hantera sin situation. Hur barnfattigdom och barnpositionen i stort förstås och framställs i en välfärdsstatlig kontext blir en relevant aspekt av dessa processer.

Analysen är baserad på en intervjustudie med 17 deltagande barn och ungdomar i åldrarna 6-18 år i familjer som är eller har varit berättigade till ekonomiskt bistånd. Syftet med intervjuerna har varit att se hur dessa barn och ungdomar upplever och hanterar ekonomisk utsatthet hemma och bland jämnåriga med fokus på deras strategier och utrymme att vara sociala aktörer. Avhandlingens teoretiska utgångspunkt är barndomssociologi och empiriska data är analyserade med en interaktionistisk ansats som belyser interaktionens betydelse och individuellt aktörskap i relation till identitetsskapande.

De strategier som deltagarna i studien ger uttryck för har tolkats utifrån en barndomssociologisk förståelse av barnpositionens begränsade handlingsutrymme, och hur deras (och andras) positionering av dem själva som barn kan skapa nya förståelser av hur fattigdomen kan hanteras. Härigenom möjliggörs en utökad problematisering av barnfattigdom genom att problematikens komplexitet belyses.

- See more at: http://www.skolporten.se/forskning/avhandling/en-erfarenhet-rikare-en-kvalitativ-studie-av-barns-strategier-och-barnfattigdomens-villkor-i-valfardsstaten/#sthash.PWtBMqSc.dpuf

This dissertation is a qualitative study which is based upon interviews with parents and caretakers of profoundly mentally disabled people.Firstly, the dissertation analyzes the subjects' evaluation of the quality of life of the mentally disabled person. The analysis focuses upon how the intellectual disability affects thinking, emotional life and relationships. The question of the mentally disabled person's well-being is in focus here.Secondly, it is shown how people in close relationships to the mentally disabled person obtain knowledge about the person's inner life through communication with him or her and through interpreting his or her behavior and body expressions.Thirdly, the dissertation investigates how some influential theories on quality of life can contribute to an understanding of profoundly mentally disabled peoples' well-being.The dissertation concludes with a reflection upon the disabled persons' dignity

En orolig själ : en berättelse om att vara manodepressiv
Kay Jamison, professor i psykiatri och en internationell auktoritet på manodepressiv sjukdom, ger här ett märkligt och högst personligt vittnesbörd: En skildring av hur hon själv sedan unga år brottats med manodepressivitet och hur den kampen format hennes liv. Det mörka ämnet till trots, genomsyras boken av en stor portion humor.
Författaren tar oss med in i den lika fascinerande som skrämmande värld som den här typen av vansinne utgör – en värld där den ena polen är det lockande tillstånd där tankar och känslor inte vet några gränser, och den andra en öken av livlös förstening där döden ofta framstår som den enda utvägen.
Kay Jamison drabbades av sin sjukdom när hon var sjutton år, och den följde henne genom skolår och universitetsstudier, genom passionerad kärlek och gränslös sorg, genom maniska skov och ett självmordsförsök som sånär kostat henne livet. Hon beskriver också det plågsamma dilemma som sjukdomen ställde henne inför: att ta litium, en medicinering som innebar att hon gick miste om topparnas hänförelse. Hon hade dessutom lärt sig att en bra flicka reder sig själv, dvs utan medicin. Men – med hjälp av kunskap, livsvilja, adekvat medicinering och, mer än något annat, kraften från ett kärleksfullt förhållande finner hon vägen till ett meningsfullt liv.

Att vara så övergiven, så oskyddad, så utsatt som detta barn som här beskrivs, ter sig för de flesta människor helt obegripligt. Varför såg ingen, varför förstod ingen - hur kunde detta fortgå?

Denna bok är en upprättelse - både för den kvinna som skrivit boken - och för andra som kämpar med känslan att "inte vara som andra" och mot människors oförmåga att förstå.

Professor Christopher Gillberg, som är Gunilla Gerlands läkare påpekar i sitt förord att boken handlar om "den hårfina gränsdragningen mellan friskt och sjukt, normalt och onormalt, icke diagnos - diagnos och om dolda handikapp". Han säger också att "Gunilla Gerlands eget språk öppnar många fler dörrar till förståelse än någon psykiaters fackjargong".

Ett övergripande syfte med avhandling var att belysa den levda erfarenheten av att vara i medelåldern och närstående till en person som insjuknat i stroke för första gången och studera de närståendes erfarenheter av förändringen över tid under det första året efter utskrivning till hemmet, samt att belysa innebörden av medelålders makars levda erfarenhet av relationen till en partner som insjuknat i stroke; under det första året. Avhandlingen omfattar 4 delstudier (I-IV) som sammantaget utgör en longitudinell studie. Tio närstående (40 - 64 år) till personer insjuknade i stroke (förstagångs insjuknande) med förväntat hjälpbehov överstigande 6 månader, inkluderades konsekutivt i studien och följdes under ett år efter utskrivning till hemmet. Narrativa intervjuer utfördes en månad (I, n=10), sex månader (II, n=9) och ett år (III, n=9) efter utskrivning till hemmet. Bland de närstående i delstudie I-III fanns fyra kvinnliga makar (gifta; n=2, sambo; n=2) som utgjorde deltagarna i delstudie IV. För att analysera data användes en fenomenologisk hermeneutisk tolkningsmetod (I, IV) och kvalitativ innehållsanalys (II, III).Avhandlingen visar på att vara i medelåldern och närstående till en person som insjuknat i stroke, efter utskrivningen till hemmet, innebär att gå igenom en förändringsprocess i olika steg. Upplevelsen var att en månad efter utskrivningen kämpa för att inte tappa fotfästet i en otrygg livssituation, där de upplevde ett främlingskap inför situationen, sig själv och personen som insjuknat i stroke. Ändå svarade de närstående oreflekterat an ett krav på ansvar och omsorg (I, IV). Efter sex månader visade de närstående på en kamp för att integrera förändringarna orsakade av stroke till det dagliga livet, förlika sig med förlusterna och att hitta balans och en ny normalitet (II). Makarna förde en kamp för att återfå känslan av samhörighet med sin partner och hitta tillbaka till sin egen identitet som maka, vilket bara var möjligt i frånvaro av en vårdarroll (II, IV). Efter ett år tvingades de närstående att erkänna, lära sig hantera och förlika sig med förändringarna orsakade av strokeinsjuknandet (III). Makarna fick lämna en ?bild? av hur deras partner en gång varit. En trygg relation i samvaro och jämlikhet med en känsla av ?vi? förändrades och blev främmande och ojämlik och ersattes med en känsla av ?jag? och ?du?. För att härda ut måste makarna omvärdera relationen till sin partner och målen i livet. Även om partnern fortfarande var i livet visade makarna en sorg och ett lidande beroende på förlusten av den relation de en gång haft till personen som insjuknat i stroke (IV). Avhandlingen visar även att de närstående inte upplevde sig varit sedda och bekräftade av den professionella vårdpersonalen i sin egen situation som närstående. Vårdens fokus upplevdes hela tiden enbart vara den sjuke och främst de fysiska förändringarna hos personen med stroke. De närståendes upplevelse var av oförståelse för innebörden av de kognitiva och emotionella förändringarna hos den sjuke (I, II, III). De närstående gav så småningom också upp sin strävan att bli bekräftade vilket innebar att bära på ett lidande som inte blev synliggjort (III). En annan del av förändringsprocessen var att de närstående gick ifrån självförnekelse med fokus på den som insjuknat och nuet (I), till en medvetenhet om att ta egna behov i beaktande (II) och att även fokusera på eget välbefinnande för att orka i en framtid (III). Avhandlingen visar att de medelålders närstående går igenom en transitionsprocess, där upplevelser av förluster, förändringar, lidande och sorg finns relaterat till; dåtid, nutid och framtid. De närståendes upplevelse av oförståelse och brist på känsla av bekräftelse i deras livssituation under året efter utskrivningen till hemmet, kan leda till en känsla av ensamhet och övergivenhet både inom de närstående själva, men också i förhållande till andra och världen utanför.

Under sommaren 2009 kom en ändring i socialtjänstlagen angående anhörigstöd. Förändringen gick från att kommuner bör ge stöd till att man ska ge stöd till anhöriga. Lagen innebär att kommunen ska underlätta för den som stödjer en närstående. Till följd av detta så beslutade Kristinehamn och Säffle kommun sig för att utvärdera kommunernas befintliga stöd och dessutom undersöka vilket behov som fanns hos anhöriga. FoU Välfärd Värmland fick uppdraget att konstruera en enkät och därefter genomföra undersökningen i Kristinehamn och Säffle kommun. Föreliggande rapport redovisar resultatet från denna undersökning. Rapporten vänder sig till alla med intresse för arbete med anhörigstöd.

Under sommaren 2009 kom en ändring i socialtjänstlagen angående anhörigstöd.
Förändringen gick från att kommuner bör ge stöd till att man ska ge stöd till
anhöriga. Till följd av detta beslutade sig Kristinehamn och Säffle kommun för att
utvärdera kommunernas befintliga stöd och dessutom undersöka vilket behov som
finns hos anhöriga. FoU Välfärd Värmland fick uppdraget att konstruera en enkät
och därefter genomföra undersökningen i Kristinehamn och Säffle kommun.
För uppbyggnaden av enkäten genomfördes sju stycken djupintervjuer med
anhöriga från båda kommunerna. De analyserades enligt en Grounded theory
ansats. Det framkom tre kategorier av behov och de var information, kunskap samt
egen tid. Det framkom även viktiga faktorer för rollen som anhörig som inte direkt
kan härledas till behov men som inte kunde uteslutas i undersökningen. Andra
betydelsefulla fynd som framkom i intervjuerna var att fokus gärna var på den
närstående och dennes välbefinnande och det var som anhörig svårt att se sina egna
behov. Så trots att undersökningens fokus var på anhörigas behov gick det således
inte att utesluta att rollen som anhörig präglas av den närståendes välbefinnande
och hur dennes situation såg ut. En annan faktor som framkom var att
anhörigsituationen kan ses som en process med olika skeden. Anhöriga visade sig ha
olika behov under olika faser. Det fanns även behov och faktorer som var mer eller
mindre relevanta beroende på vilken funktionsnedsättning den närstående hade.
Utifrån vad analysen av intervjuerna genererade konstruerades därefter enkäten.
Totalt deltog 286 anhöriga i enkätundersökningen i Säffle kommun. Av de som
besvarade enkäten utgjorde män 38,6% och kvinnor 61,4% och medelåldern var 63,7
år. I Kristinehamns kommun deltog 308 anhöriga varav 36,0% var män och 64,0%
var kvinnor. Medelåldern bland dessa anhöriga var 62,6 år.
Resultatet visade att det var samma fem behov som var viktigast för anhöriga i båda
kommunerna. De hade behov av information om; hjälpmedel, trygghetslarm, vilka
insatser som finns tillgängliga till den närstående och vilka krav den närstående kan
ställa samt behov av färdtjänst. Resultatet visade också att de 13 främsta faktorerna
som anhöriga tycker var viktiga var samma i båda kommunerna. Det tyder på att det
är faktorer som anhöriga värderar som viktigt oberoende av hemkommun. Det
anhöriga värderade främst var professionalitet, bemötande och kontinuitet bland
personal som stöder deras närstående. De tyckte också att miljön på boendet var
viktigt samt att boendet var rätt utrustat och anpassat. Information av olika slag var
det som anhöriga var i behov av mest i båda kommunerna. Det var få anhöriga i
Säffle kommun som sa sig inte behöva någon information alls. I praktiken var det
över 95% av alla anhöriga som på något sätt var i behov av information i rollen som
anhörig. I Kristinehamns kommun var denna siffra 83%. Överlag var behovet av
information stort bland anhöriga.
Det fanns både positiva och negativa aspekter med att betrakta anhörigas behov med
avseende på den närståendes funktionsnedsättning. För anhöriga till närstående med
psykiskt funktionshinder samt missbruk/beroendeproblematik var det viktigt att
behoven analyserades utifrån den närståendes funktionsnedsättning. Svårigheten
var att närstående kunde ha fler än en funktionsnedsättning och därmed kunde en
anhörig "tillhöra" fler grupper.
Det är komplext med stöd för anhöriga. Det finns insatser till närstående som
indirekt blir till stöd för den anhörige. Men det är den närstående i slutändan som
ansöker om detta. Vill inte den närstående ta emot hjälp, en insats, så kan det leda
till att den anhöriga får ta konsekvenserna av detta.
Enligt utvärderingen av Säffle kommuns befintliga stöd var det över 80% som var
nöjda eller mycket nöjda med stöd som trygghetsplats, växelvård, dagvård för
personer med minnesproblem samt dagverksamhet. De två sistnämnda stöden hade
dock en mindre andel som var mindre nöjda eller inte alls nöjda än vad växelvården
och trygghetsplats hade. Stödet "avlastning i hemmet" hade flest, 53,3% varit mycket
nöjd med. Å andra sidan så var det 40% som var mindre nöjda eller inte alls nöjda
med samma stöd. I Kristinehamns kommun var det fyra typer av stöd som över 82%
av anhöriga var nöjda eller mycket nöjda med. Dessa var, rangordnat,
trygghetsplats, hemvårdsbidrag, dagvård för personer med minnesproblem samt
avlastning i hemmet.

Doktorsavhandling

Even though medical improvements have reduced the mortality rates for patients afflicted by stroke, mortality during the first few days at hospital is significant. Today, there is an increasing recognition that the principles of palliative and supportive care are important components of meeting the needs of patients severely afflicted by stroke even in acute settings. However, there is limited knowledge about which factors have an impact on the end-of-life care (EoLC) for these patients or about how these last days of life are experienced from the family members' perspective. Aim The overall aim of this thesis was to describe the EoLC of patients severely afflicted by stroke and to identify factors impacting upon EoLC for the patients and their family members in Sweden out of various contexts and methods. Design and Methods This thesis is based upon four papers employing qualitative, quantitative and mixed-method designs. Paper I is a qualitative study based on focus-group interviews with 41 health-care professionals (HCPs) in different professions related to stroke care at three stroke units. The aim was to study ethical dilemmas, different approaches and what consequences they had among health HCPs; the data was analysed using content analysis. The result inspired the design and conduct of the following studies. Paper II is a quantitative comparative study based on a retrospectively registered questionnaire from the Swedish Registry of Palliative Care (SRPC). Patients dying of stroke (n =1626) were compared with patients dying from cancer (n=1626), according to symptoms, symptom management and communication with the patient and family members during the last week of life. Data was statistically calculated using OR. Paper III is a mixed-method study employing a sequential explanatory design. In the first, quantitative, part, 995 stroke patients who died in hospital were compared with 631 stroke patients who died at nursing homes, according to symptoms, symptom management and communication with the patient and family members during the last week of life. The quantitative data was statistically calculated using OR and the qualitative data was analysed using content analysis. Nine significant differences drawn from the quantitative results regarding care were chosen to be discussed by twelve nurses working in stroke units. Paper IV is a qualitative interview study with the aim to study the family member descriptions of the trajectory from admission to the hospital until their loved one died. A semi-structured interview guide was used, and data was analysed using thematic analyses. Results Factors that had an impact on EoLC were consequences related to the difficulties around decision-making about withholding or withdrawing life-sustaining treatment. Non-decisions or not holding to the decision generated communication barriers causing obstacles in inter-professional collaboration and ethical dilemmas within the team (Study I). The absence of a mutual approach to care resulted in underprovided palliation, undignified medical treatment and ambiguity in care, generating feelings of distrust among the family members. The results described in Study I of underprovided palliation were further investigated in Study II. The differences in knowledge about whether symptoms were present or not in patients afflicted by stroke compared to patients with cancer were significant. For example, the HCPs in the stroke group did not know if pain was present nine times more frequently than in the cancer group. These differences in knowledge about whether symptoms were present of not were also identified in Study III. Here, HCPs at the nursing home more often had knowledge about whether a symptom was present in patients dying of stroke or not, compared to HCPs at hospitals. This study also identifies differences in the presence of the symptoms being compared and whether the patient's suffering was fully relieved. The nurses working at stroke units explained that these differences were a consequence of the stroke unit's aim (saving lives), no previous relationship to the patient and ambiguity in the evaluation of symptoms. The patient's altered levels of consciousness increased the difficulties in evaluation. In addition, the hospital setting's aim increased the risk of prolonged treatment, for example nutrition supplied during the last day of life, and underprovided palliation of for example, pain compared to nursing homes. In Study IV, family members were seeking trust through mutual collaboration and creating relationships with the HCPs. If the family did not feel that their search for trust was taken care of, it generated feelings of distrust allied with anxiety and memories of failing to do the best for their loved one at in the end of life. During the trajectory at the hospital, family members were "seeking trust in chaos", "seeking clarity when deciding about living or dying" and finally they were "seeking trust in care as a final act of love". Conclusions: The results of this thesis suggest that the absence of a coherent approach contributes to developing ethical dilemmas within the HCPs. The ambiguity in care had an impact on the quality on EoLC, with an increased risk of unnecessary suffering and questionable symptom management. The prevailing culture at acute-care hospitals affected the HCPs' attitudes towards EoLC, with attention being predominantly on life-sustaining treatments. There is an increasing recognition of the need for improvement in the PC approach at acute-care hospitals in order to create equal quality of care during end of life, irrespective of the place of death for patients dying of stroke. Furthermore, family members need to feel trust, which is achieved through relationships and collaboration with HCPs. In the striving to accomplish a wholly compensatory care of quality during the trajectory, this thesis can be a source of knowledge and guidance for nurses and for teams at the stroke unit.

Behavioral parent training (BPT) is one of the empirically supported psychosocial treatments for ADHD. Over many years and in many studies, BPT has been documented to improve both child ADHD behavior and maladaptive parenting behavior. In some studies, BPT has also been found to result in benefits in additional domains, such as parenting stress and child classroom behavior. However, the BPT literature on children selected as having ADHD lags behind research conducted on BPT for children selected as having oppositional defiant and conduct disorders (ODD and CD, respectively) with regard to examination of factors that may limit treatment attainment, compliance, and outcomes, such as single parenthood, parental psychopathology, and child comorbidity. Because of the high degree of comorbidity between ADHD and ODD/CD, it is difficult to separate the two BPT literatures. The parameters of BPT (e.g.. format and setting), parent factors, and child factors that may contribute to treatment outcomes for families of children with ADHD are reviewed here and recommendations for future BPT research in the area of ADHD are made.

Young children who have experienced early adversity are at risk for developing disorganized attachments. The efficacy of Attachment and Biobehavioral Catch-up (ABC), an intervention targeting nurturing care among parents identified as being at risk for neglecting their young children, was evaluated through a randomized clinical trial. Attachment quality was assessed in the Strange Situation for 120 children between 11.7 and 31.9 months of age (M = 19.1, SD = 5.5). Children in the ABC intervention showed significantly lower rates of disorganized attachment (32%) and higher rates of secure attachment (52%) relative to the control intervention (57% and 33%, respectively). These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk for maltreatment.

Young children who have experienced early adversity are at risk for developing disorganized attachments. The efficacy of Attachment and Biobehavioral Catch-up (ABC), an intervention targeting nurturing care among parents identified as being at risk for neglecting their young children, was evaluated through a randomized clinical trial. Attachment quality was assessed in the Strange Situation for 120 children between 11.7 and 31.9 months of age (M = 19.1, SD = 5.5). Children in the ABC intervention showed significantly lower rates of disorganized attachment (32%) and higher rates of secure attachment (52%) relative to the control intervention (57% and 33%, respectively). These results support the efficacy of the ABC intervention in enhancing attachment quality among parents at high risk for maltreatment.

Even though multisensory environments (MSE) incorporate artifacts and technology to provide sensory stimuli, most of these artifacts are non-interactive. Twenty-four children with profound developmental disabilities from three MSE institutions have been involved in a research study. A handful of interactive design artifacts, which have been developed as a tool for ideation and to enhance the use of MSE by promoting children's engagement are presented. With these artifacts the children have shown us a vast topology of interaction and bodily engagement, showing a potential for haptic and audio interactive design fields to contribute to a more participatory MSE practice.

The purpose of this qualitative study of families where a parent has cancer was to explore ways of informing the child of the parent's illness, how the child perceives the parent's emotional state, how the child copes with the parent's illness, and how this coping relates to the parent's coping and concerns for the child. Twenty-one children from 15 families and their parents were interviewed. In 13 families the mother was ill, in two the father. Children were aware of the facts of the illness, but there was limited emotional communication between the generations. The children were very observant of both the ill and the healthy parent's emotional condition. The children's observations and expressions led us to identify five coping strategies the younger generation used: Helping others, parentification, distraction, keeping it in the head, and wishful thinking. Both adaptive and destructive examples of parentification were found. Communication patterns and parental coping seemed to be highly related to the child's coping repertoire. Even though most children seemed to manage rather well, all children were strongly affected by the illness. The 'healthiest' adaptation related to factors within the family system, which has implications for the provision of help.

Abstract:
In light of current pressures within formal social care services, informal carers assume an important role in meeting the care needs of a growing number of older people. Research suggests relationships between care-giving and health are complex and not yet fully understood. Recently, wide-ranging associations between sleep and health have been identified, however, our understanding of the links between care-giving and sleep is limited at present. This study assesses longitudinal patterns in co-resident care-giving and problematic sleep among older people in the United Kingdom. Our sample included 2,470 adults aged 65 years and older from the UK Household Longitudinal Study. Problematic sleep was defined as two or more problems in going to sleep, staying asleep or sleep quality. Using logistic regression models, we assessed how co-resident care-giving status, intensity and transitions influence the likelihood of problematic sleep in the following year, adjusting for potential confounding factors. Adjusted analyses found co-resident care-givers were 1.49 (95% confidence interval = 1.06–2.08) times more likely to report problematic sleep in the following year, relative to those not providing care. Care-giving over 20 hours per week and continuous co-resident care-giving also significantly increased the odds of problematic sleep. This suggests older co-resident care-givers may be at greater risk of incurring sleep problems than non-care-givers. Further longitudinal research is needed to investigate care-giver-specific consequences of poor sleep.

This chapter presents research on resilience of children and adolescents who have experienced two major disruptions of the nuclear family, parental divorce and parental bereavement. The two research programs share a common research paradigm in which there is an iterative relationship between correlational and experimental studies (Sandler, Wolchik, MacKinnon, Ayers, & Roosa, 1997). Correlational studies are used to identify protective and vulnerability factors, particularly those that may be modifiable by planned interventions. Experimental studies are designed on the basis of the small theory that changing these factors in the desirable direction will promote resilience. Randomized experimental trials of the interventions are conducted to test whether the intervention has changed these vulnerability and protective factors and reduced negative outcomes and whether change in negative outcomes is mediated by change in the vulnerability and protective factors (Sandler et al., 1997). The mediational analysis within the randomized trial provides a stronger test of the causal role of the vulnerability and protective factors to influence negative outcomes than is provided by the correlational studies, and thus contributes to theory about resilience (Rutter, Pickles, Murray, & Eaves, 2001).

The chapter first presents a theoretical framework that specifies alternative models of the influence of vulnerability and protective factors on the resilience of children experiencing significant adversities. We then discuss correlational research on key constructs in the theoretical framework: adversity, and child and family protective and vulnerability factors.

We compared neural activation detected by magnetoencephalography (MEG) during tactile presentation of words and non-words in a postlingually deaf-blind subject and six normal volunteers. The left postcentral gyrus, bilateral inferior frontal gyri, left posterior temporal lobe, right anterior temporal lobe, bilateral middle occipital gyri were activated when tactile words were presented to the right hand of the deaf-blind subject. This set of activated regions was not observed in the normal volunteers, although activation of several combinations of these regions was detected. Positron emission tomography confirmed the location of the MEG-activated areas in the deaf-blind subject. Our results demonstrated that the deaf-blind subject is heavily involved in interpreting tactile language by enhancing cortical activation of cognitive and semantic processing. © 2004 Lippincott Williams & Wilkins.

Recent studies have found short-term adrenocortical benefits of early interventions for at-risk children. The current study evaluated the effects of the Family Bereavement Program on cortisol levels six years after the program. Parentally bereaved children were randomly assigned to the 12-week preventive intervention (n=78) or a self-study control (n=61) condition. Six years later (mean age 17.5), salivary cortisol levels were measured before and after a conflict discussion task conducted in late afternoon/early evening. The intervention group had significantly higher cortisol levels across the task compared to the control group, and lower cortisol was associated with higher externalizing symptoms. The group effect did not differ by age at the time of death, and the group difference remained significant after adjustment for pre-intervention mental health and current mental health symptoms. Results suggest that a family-focused intervention for parentally bereaved youth may have prevented the development of attenuated cortisol secretion suggestive of dysregulation and associated with externalizing problems.

Background and Purpose— Early supported discharge (ESD) for stroke has been shown to yield outcomes similar to or better than those of conventional care, but there is less information on the impact on costs and on the caregiver. The purpose of this study is to estimate the costs associated with an ESD program compared with those of usual care.

Methods— We conducted a randomized controlled trial of stroke patients who required rehabilitation services and who had a caregiver at home.

Results— Acute-care costs incurred before randomization when patients were medically ready for discharge averaged $3251 per person. The costs for the balance of the acute-care stay, from randomization to discharge, were $1383 for the home group and $2220 for the usual care group. The average cost of providing the 4-week home intervention service was $943 per person. The total cost generated by persons assigned to the home group averaged $7784 per person, significantly lower than the $11 065 per person for those assigned to usual care. A large proportion of the cost differential between the 2 groups arose from readmissions, for which the usual care group generated costs more than quadruple those of the home intervention group.

Conclusions— Providing care at home was no more (or less) expensive for those with greater functional limitation than for those with less. Caregivers in the ESD group scored consistently lower on the Burden Index than caregivers with usual care, even caregivers of persons with major functional limitations. For persons recovering from stroke and their families, ESD provides a cost-effective alternative to usual care.

Counselling. Stödsamtal i social arbete. S. Larsson and S. Trygged

This study examines whether and how couples share the provision of informal care for their parents. Four waves of the British General Household Survey contain cross-sectional information about caring for parents and parents-in-law. Descriptive and multivariate analyses were conducted on 2214 couples that provided parent care. The findings emphasise married men's contribution to informal caring for the parental generation and at the same time demonstrate the limits of their involvement. Spouses share many parts of their care-giving but this arrangement is less common with respect to personal and physical care. The more care is required the more likely are people to participate in care for their parents-in-law. More sons-in-law than daughters-in-law provide care but, once involved, daughters-in-law provide on average more hours of care than sons-inlaw. Own full-time employment reduces both men's and women's caring for their parents-in-law, and men's caring drops further if their wife is not in the labour market. The findings suggest that daughters-in-law often take direct responsibility whereas sons-in-laws' care-giving depends more on their wives' involvement. Children-in-laws' informal care-giving might decrease in the future because of women's increasing involvement in the labour market and rising levels of nonmarital cohabitation in mid-life.

The study compared the effect of couples-based vs individual-based therapy for men who entered outpatient substance abuse treatment on the psychosocial functioning of children in their homes. Men were randomly assigned to (1) behavioral couples therapy (BCT), (2) individual-based treatment (IBT) or (3) couples-based psychoeducational attention control treatment (PACT). For both children of alcohol (N=71) and drug-abusing men (N=64), parents' ratings of children's psychosocial functioning was higher for children whose fathers participated in BCT at posttreatment and at 6- and 12-mo follow-up than for children whose fathers participated in IBT or PACT. BCT resulted in greater improvements in parents' dyadic adjustment and fathers' substance use. Thus, couples-based intervention that addresses both issues may have greater benefits for children in these homes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

The aim of this thesis was to describe how early triadic interaction between the newborn child and its mother and father begins, develops, and matures over the child's first 4 years of life. Systemic family theory and developmental theory are combined to go beyond the "mother-child" dyad to the "mother-father-child" triad. Lausanne Trilogue Play (LTP, originally Lausanne Triadic Play) was developed by Elisabeth Fivaz and her learn in Lausanne, Switzerland, and used to carry out standardised studies of child-mother-father interaction. The family is placed in a triangle that allows all three partners optimal access to each other. The focus of this thesis was to describe triadic interaction when all members of the triad interact with each other. It is based on a pioneering longitudinal and prospective study. It was begun with interviews when the parents were expecting their first child. The development of triadic interaction was then monitored by repeated, videotaped LTP observations when the child was 3, 9, 18, and 48 months of age. The study is part of an international collaboration to describe the development of triadic interaction in four groups: 20 Swiss German-speaking families, 20 Swiss French-speaking families, 20 American families (Seattle, Washington, USA), and 20 Swedish families. In Sweden, consecutive Swedish-speaking couples were recruited by midwives at a maternity health care clinic in Stockholm. Twelve boys and 8 girls were born. To analyse the children's communicative skills in relation to their behaviour at age 4 years, the preschool teachers were asked to fill in the Preschool Behaviour Questionnaire (PBQ). The author developed the Child-Parents-Interaction Coding System (CPICS) to analyse quantitative and qualitative variables in triadic interaction. The CPICS was used to analyse LTP observations of the Swedish families over time and to compare the Swedish and American groups of families. One child, a girl, exhibited a typical development. At the age of 5 she was referred to a child and adolescent neuropsychiatric department where, at the age of 7 years, she was diagnosed with an autism spectrum disorder. She was excluded from the group analysis and instead presented as a case report. When the children were 3 months of age, parents held back concerning contribiltion (the starting point for a sequence of interactions) and allowed the "child's just being- to launch conversation. This pattern persisted up to 48 months, with the parents giving the child space. Types or child contributions varied over time. When the child was 3 months old, its parents treated all its behaviours as contributions for starting points of conversation, while child contributions at 48 months generally had a communicative character. Coparenting seems to set the structure for early communication by using various nonverbal, vocal, and verbal methods to support the child in turn-taking sequences. A cultural difference in the tempo of play between American and Swedish families was found. Although both groups of families interacted in a synchronized and reciprocal way, the pace of play in triadic interaction was taster in American families. Positive correlations between complex triadic interaction (number of turn-taking sequences) at 3, 9, and 18 months (significant at 9 months) and preschool teachers' assessments of children's social competence at 48 months suggest some predictive power of this variable in the assessment system. The autistic girl and her parents exhibited deviations in early triadic communication - most clearly when she was 9 months old. Findings are discussed regarding their importance concerning early interventions in the family system.

This article looks at how the children of disabled parents are being defined as 'young carers', arguing that the way in which this is hap pening undermines both the rights of children and the rights of disabled people, Analysis of the social construction of 'children as carers' illustrates that researchers and pressure groups are colluding with the government's insistence that 'care in the community' must mean 'care by the community'.

Rapporten beskriver ett utvecklingsarbete inom FoU Skåne som haft som mål att finna former för brukare att framföra synpunkter, önskemål och krav på den verksamhet som de tar del av. Utgångspunkten har varit Empowerment - ett begrepp som här huvudsakligen använts för att belysa brukarnas möjlighet att bestämma över sina liv och erövra egenmakt - ett exempel på en botten-uppstrategi för inflytande.

Metoden som benämnts Delaktighetsmodellen har inspirerats av andra former för brukarinflytande som BIKVA och Lyttemöten från Danmark och BUKU från Sverige.

Rapportens första del är en beskrivning av processen och den implementering som skett i Skåne under tre år. Den andra delen kan ses som en fördjupning av motiven och en beskrivning av de bakomliggande teoretiska begreppen.

Self-harming behaviour among adolescents, and particularly adolescent girls, has evoked much public attention. This article presents a Swedish study about what information assessment and treatment agencies have about self-harming behaviour in the form of cutting and burning in adolescent girls. The study was made on assignment by the Swedish National Board of Health and Welfare. All public agencies assessing or treating adolescents with psychological problems in three Swedish cities were asked to deliver information about self-harming behaviour in the form of self-cutting or self-burning in girls between 13 and 18 years of age. In addition, the young offender institutions within the National Board of Institutional Care treating teenager girls were asked to deliver information about self-harming behaviour in their clients. We found that about 1% of the total population of girls in these ages were known to have cut or burnt themselves and about one third of the girls in the institutions. Attempts to distinguish subgroups among the girls were only partly successful. Although some subgroups could be identified, the overlap between them was large. The conclusion was that this behaviour may be seen as an expression of a wide variety of problems in a heterogeneous group of young persons. © 2007 Springer Science+Business Media, LLC.

BACKGROUND:
Trends in deliberate self-harm (DSH) are important because they have implications for hospital services, may indicate levels of psychopathology in the community and future trends in suicide, and can assist in identification of means of suicide prevention.
METHOD:
We have investigated trends in DSH and characteristics of DSH patients between 1990 and 2000 based on data collected through the Oxford Monitoring System for Attempted Suicide.
RESULTS:
During the 11-year study period 8590 individuals presented following 13858 DSH episodes. The annual numbers of persons and episodes increased overall by 36.3% and 63.1% respectively. Rates (Oxford City) declined, however, in the final 3 years. There were gender- and age-specific changes, with a rise in DSH rates in males aged > or = 55 years and in females overall and those aged 15-24 years and 35-54 years. Repetition of DSH increased markedly during the study period. Antidepressant overdoses, especially of SSRIs, increased substantially. Paracetamol overdoses declined towards the end of the study period. Alcohol abuse, use of alcohol in association with DSH, and violence increased, especially in females, and the proportion of patients in current psychiatric care and misusing drugs also rose.
CONCLUSIONS:
While overall rates of DSH did not increase markedly between 1990 and 2000, substantial changes in the characteristics of the DSH population and a rise in repetition suggest that the challenges facing clinical services in the management of DSH patients have grown.

BACKGROUND: Family caregivers in palliative care have a need for knowledge and
support from health professionals, resulting in the need for educational and
supportive interventions. However, research has mainly focused on the experiences
of family caregivers taking part in interventions. To gain an increased
understanding of complex interventions, it is necessary to integrate the
perspectives of health professionals and family caregivers. Hence, the aim of
this study is to explore the perspectives of health professionals and family
caregivers of delivering and participating in a psycho-educational intervention
in palliative home care.
METHODS: A psycho-educational intervention was designed for family caregivers
based on a theoretical framework describing family caregiver's need for knowing,
being and doing. The intervention was delivered over three sessions, each of
which included a presentation by healthcare professionals from an intervention
manual. An interpretive descriptive design was chosen and data were collected
through focus group discussions with health professionals and individual
interviews with family caregivers. Data were analysed using framework analysis.
RESULTS: From the perspectives of both health professionals and family
caregivers, the delivering and participating in the intervention was a positive
experience. Although the content was not always adjusted to the family
caregivers' individual situation, it was perceived as valuable. Consistently, the
intervention was regarded as something that could make family caregivers better
prepared for caregiving. Health professionals found that the work with the
intervention demanded time and engagement from them and that the manual needed to
be adjusted to suit group characteristics, but the experience of delivering the
intervention was still something that gave them satisfaction and contributed to
them finding insights into their work.
CONCLUSIONS: The theoretical framework used in this study seems appropriate to
use for the design of interventions to support family caregivers. In the
perspectives of health professionals and family caregivers, the
psycho-educational intervention had important benefits and there was congruence
between the two groups in that it provided reward and support. In order for
health professionals to carry out psycho-educational interventions, they may be
in need of support and supervision as well as securing appropriate time and
resources in their everyday work.

Despite an almost universal policy of community care, placing a relative in a care home will be an increasingly common event as population ageing continues. Studies suggest that most families wish to remain involved in care following placement but that they often experience difficulties in establishing relationships with staff. This paper reports on the fifth phase of a Swedish study exploring the experience of placement from a temporal perspective and including the views of all the key actors (relatives, staff in the community, staff in care homes). The focus here is placed on the perceptions of care home staff and their perceived role in relation to spouses who have recently placed a partner. The study adopted a grounded theory approach and data were collected from in-depth interviews with 16 staff members of varying grades and positions. Analysis of the data suggested 3 levels of awareness amongst staff: empathic awareness, guarded awareness and limited awareness. The characteristics of empathic awareness are outlined and its implications briefly considered.

Camilla Öhmans gripande berättelse om sin mamma som insjuknade och avled i en avancerad form av demenssjukdom som heter Frontallobsdemens. Boken är ärligt skriven om egna livserfarenheter och beskriver dem olika händelseförlopp och stadier i sjukdomen, bemötandet inom vården samt ger anhöriga konkreta råd på vägen. Som läsare kommer du även få ta del av guldkornen i en familjs historia om en stark kärlek, hyllningen till livet, föräldraskap och om envisheten att fortsätta kämpa fastän livet visar oss sin hårdaste sida.
Denna ljudbok är skapad för att hjälpa andra anhöriga som lever nära en person som är sjuk i en demenssjukdom men även för dem som önskar få en bättre förståelse om sjukdomen som sådan. Det är viktigt att belysa hur dessa personer med denna form av sjukdom och dess anhöriga bemöts av samhället idag. Det är dags att våga börja prata öppet om dessa sjukdomar för att påverka situationen med att se till att de demenssjuka ska få en bra vård, men även att dem anhöriga ska erhålla rätt stöd då livet för dem dagligen består av olika utmaningar och andra påfrestningar som riskerar dem själva att bli sjuka.

The Holocaust left its visible and invisible marks not only on the survivors, but also on their children. Instead of numbers tattooed on their forearms, however, they may have been marked epigenetically with a chemical coating upon their chromosomes, which would represent a kind of biological memory of what the parents experienced. as a result, some suffer from a general vulnerability to stress while others are more resilient. Previous research assumed that such transmission was caused by environmental factors, such as the parents' childrearing behavior. New research, however, indicates that these transgenerational effects may have been also (epi) genetically transmitted to their children. Integrating both hereditary and environmental factors, epigenetics adds a new and more comprehensive psychobiological dimension to the explanation of transgenerational transmission of trauma. Specifically, epigenetics may explain why latent transmission becomes manifest under stress. a general theoretical overview of epigenetics and its relevance to research on trauma transmission is presented.

The Holocaust left its visible and invisible marks not only on the survivors, but also on their children. Instead of numbers tattooed on their forearms, however, they may have been marked epigenetically with a chemical coating upon their chromosomes, which would represent a kind of biological memory of what the parents experienced. as a result, some suffer from a general vulnerability to stress while others are more resilient. Previous research assumed that such transmission was caused by environmental factors, such as the parents' childrearing behavior. New research, however, indicates that these transgenerational effects may have been also (epi) genetically transmitted to their children. Integrating both hereditary and environmental factors, epigenetics adds a new and more comprehensive psychobiological dimension to the explanation of transgenerational transmission of trauma. Specifically, epigenetics may explain why latent transmission becomes manifest under stress. a general theoretical overview of epigenetics and its relevance to research on trauma transmission is presented.

The Holocaust left its visible and invisible marks not only on the survivors, but also on their children. Instead of numbers tattooed on their forearms, however, they may have been marked epigenetically with a chemical coating upon their chromosomes, which would represent a kind of biological memory of what the parents experienced. as a result, some suffer from a general vulnerability to stress while others are more resilient. Previous research assumed that such transmission was caused by environmental factors, such as the parents' childrearing behavior. New research, however, indicates that these transgenerational effects may have been also (epi) genetically transmitted to their children. Integrating both hereditary and environmental factors, epigenetics adds a new and more comprehensive psychobiological dimension to the explanation of transgenerational transmission of trauma. Specifically, epigenetics may explain why latent transmission becomes manifest under stress. a general theoretical overview of epigenetics and its relevance to research on trauma transmission is presented.

The overall aim of this thesis is to 1) investigate the prevalence of stigmatizing experiences and beliefs of devaluation and discrimination among persons with mental illness, and 2) to investigate the relationship between beliefs of devalua¬tion/¬discrimination, rejection experiences and sociodemographic/clinical patient characteristics, social networks, self esteem, empowerment and subjective quality of life. The thesis comprises four papers. Part one of the study was designed as a cross-sectional study using a convenience sample of 200 consumers in current contact with mental health services or with earlier experiences of this. In order to reach subjects with different experiences of mental illness recruitment were made at inpatient and outpatient settings, rehabilitation units and among members of user organizations. This part of the study is presented in paper I-III. In the second part of the study 25 mental health user's who participated in the cross-sectional study were interviewed with regard to experiences of rejection related to their mental illness

Christopher Gillberg är upphovsman till ESSENCE, Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations. Det är ett paraplybegrepp som betonar den stora överlappningen mellan utvecklingsneurologiska/neuropsykiatriska störningar som alltför ofta betecknas som avgränsade tillstånd till exempel adhd, autism, DCD. Minst tio procent av alla barn under 18 år har eller har haft någon eller flera av dessa problemtyper/diagnoser.

Poängen med att utgå från ESSENCE-begreppet är att det kan bidra till tidig upptäckt och förståelse för barnets hela fungerande inte bara en diagnos. Barn kan ha svårigheter med motorkoordination, sensorisk perception, kommunikation/språk, aktivitet/impulsivitet, uppmärksamhet, social interaktion/ömsesidighet samt sömn och mat. Med anpassade och tidiga insatser kan vi hjälpa barnen och förebygga problem i vuxen ålder.

Three high school students with severe disabilities were taught to participate in conversations with a number of peers in a variety of school and community settings utilizing a communication book adaptation. Additionally, during baseline, training, and informed-generalization-partner phases, measures were taken of the degree to which conversation initiation and turn taking generalized to conversation opportunities outside the instructional situation with family members and other nondisabled partners at home and in the community. During the independence phase, when students were participating in sustained conversations with a large number of peers at school, there continued to be breakdowns in conversational turn taking in probe contexts. Utilizing a multiple baseline design across students, probe partners at home and school received the information they needed to support the students with disabilities by conversing via the communication book and utilizing the conversation structure to provide additional prompts. The results showed that the number of balanced conversational turns taken following partner training immediately matched performance with informed peers at school. Finally, the study demonstrated that one family member could provide the necessary information for successful interactions to another without further input from school personnel.

Three high school students with severe disabilities were taught to participate in conversations with a number of peers in a variety of school and community settings utilizing a communication book adaptation. Additionally, during baseline, training, and informed-generalization-partner phases, measures were taken of the degree to which conversation initiation and turn taking generalized to conversation opportunities outside the instructional situation with family members and other nondisabled partners at home and in the community. During the independence phase, when students were participating in sustained conversations with a large number of peers at school, there continued to be breakdowns in conversational turn taking in probe contexts. Utilizing a multiple baseline design across students, probe partners at home and school received the information they needed to support the students with disabilities by conversing via the communication book and utilizing the conversation structure to provide additional prompts. The results showed that the number of balanced conversational turns taken following partner training immediately matched performance with informed peers at school. Finally, the study demonstrated that one family member could provide the necessary information for successful interactions to another without further input from school personnel.

This study used data on 2,453 children age 4 to 17 from the National Survey of Child and Adolescent Well-Being and 5 analytic methods that adjust for selection factors to estimate the impact of out-of-home placement on children's cognitive skills and behavior problems. Methods included ordinary least squares (OLS) regressions and residualized change, simple change, difference-in-difference, and fixed effects models. Models were estimated using the full sample and a matched sample generated by propensity scoring. Although results from the unmatched OLS and residualized change models suggested that out-of-home placement is associated with increased child behavior problems, estimates from models that more rigorously adjust for selection bias indicated that placement has little effect on children's cognitive skills or behavior problems.