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[Treatment center staff and the children referred by DDASS for specialized foster home care].

Many children placed in foster families chosen by the local administrative authorities need an intensive and complex treatment, which would well justify their case being handled by the Specialized Psychiatric Unit responsible for a number of selected foster families. The foster family, which is often chosen hurriedly, is generally unprepared to deal with the child's psychological problems. Moreover, the child's links with his own family have not always been maintained. Soon social workers and the foster mother will be expecting the local Child Psychiatry Outpatient Unit to provide them with massive aid, which this unit is not properly equipped to give. It happens frequently that members of this team will have to face particular counter-transfer difficulties. However certain aspects of this medical structure are helpful for the treatment of these children: the Child Psychiatry Unit offer specific facilities, like therapeutic groups, and as the members of its team have no part in the factual decisions concerning the fate of the child, they feel more neutral and can be considered so by the different actors involved, including the child him- or herself. We discuss two clinical cases, and then touch upon the fundamental issue involved, that of the organizing power of psychiatry in a given environment.

Child

The influence of foster-home care on psychiatric patients.

Adult patients placed into foster families by six administrations in three provinces of Canada were oberved at time of placement and followed up 18 months later. Over this period, they exhibited a substantial decline in symptoms-almost as great as with similar patients retained in the hospital. However, there was virtually no improvement in social functioning, despite the fact that the use of foster homes has been advocated mainly for the resocialization that was expected to occur there. In discussing the reasons for this paradoxical finding, recommendations are offered regarding the use of foster homes by mental health administrations.

Adult

Community-based residential care for the minimally impaired elderly: a survey analysis.

Foster home care for the elderly, as an alternative to living independently, living with relatives or living in an institution, has been a neglected area of investigation, although such care is a nationwide phenomenon. This survey of all licensed Family Care Home operators in the Louisville, Kentucky area provides baseline data regarding the characteristics of providers of adult foster care and the recipients. Data were obtained from 183 persons caring for minimally impaired adults in their own homes and on 422 residents in these foster home settings. Of the residents, 69.5 percent were aged 65 or over. Care providers are described on the basis of age, race, sex, educational level, family size and composition, previous employment, reasons for entering the business, and problems encountered. Residents are described on the basis of age, race, sex, physical condition, care required, and outside contacts. Foster home care for the aged can furnish many advantages if the resident is properly placed and support services are provided. This form of care deserves much greater emphasis in future research of the provision of services for the elderly.

Activities of Daily Living

Cooperative apartments: new programs in community mental health.

The potential of cooperative apartments as an alternative in residential care for former mental patients is only beginning to be explored. Existing programs demonstrate the viability of these apartments as a last stepping-stone to be used by patients as they move toward a completely independent way of life. In contrast to other residential arrangements, such as foster home care or halfway houses, cooperative apartments seem on balance to be less likely to induce patient dependence or to have an aura reminiscent of the hospital to patients. Moreover, they are relatively inexpensive, can be established without attracting untoward attention in the community, and permit their occupants to live more like other people and with comparatively little stigma. As indicated by the variety of sponsoring agencies described in this article, the impetus to establish cooperative apartments can come from many sources. Such diversity is currently necessary. Only through the evaluation of different models and their effectiveness will criteria be established for a national policy regarding residential care.

Community Mental Health Services

They can go home again!

A pilot project demonstrates that a carefully designed program encompassing training of foster parents, use of volunteers, community support and full commitment by foster care workers can produce permanent homes for youngsters.

Child

Foster placement for the older psychiatric patient.

The effect of age on foster care outcome was examined for 572 male psychiatric patients referred for foster care from five VA hospitals. Subjects were assigned randomly to preparation (experimentals) or continued inpatient care (controls.) Research staff collected data on social functioning, mood, activity, and adjustment. Only 79 (14%) were 60 years or older. Compared with younger patients, those 60 and over were more likely to be diagnosed as having chronic brain disease and less likely to be diagnosed as have schizophrenia. About 70% of the younger and older experimentals were placed into foster care. Alcoholics and persons with more hospitalizations were significantly less likely to be placed. Patients in foster care changed significantly compared with hospitalized controls by having less social dysfunction and better adjustment. Older subjects improved as a result of being seen in the hospital prior to placement but were not different from younger subjects in how they responded to the foster home. The study suggests that foster care is an appropriate and underutilized resource for elderly psychiatric patients.

Adaptation, Psychological

From hospital to community care: the change in the mental health treatment system in California.

In 1968 California enacted a law transforming its state hospital centered mental health services to a single system of patient care based on local community responsibility. The 1968 law was not the cause of radical change in California, but rather the culmination of a process that began three decades earlier. The 1963 federal regulation enabling former mental patients to become eligible for categorical aid through public assistance programs and the development of psychoactive drugs were two necessary catalysts that provided the opportunity ot maintain many formerly hospitalized mental patients in the community and to avoid lengthy hospitalization of others.

California