Clinical Characteristics of Older Adults Living in Foster Families in the French West Indies: Baseline Screening of the KArukera Study of Aging in Foster Families (KASAF) Cohort.

Background and Objectives: Foster families for older adults could represent a transitional or alternative model to nursing homes. The aim of this study was to describe the clinical characteristics of older adults in foster families and to compare them with those of residents in nursing homes in French West Indies. Research Design and Methods: This study is a cross-sectional analysis of the KArukera Study of Aging in Foster Families (KASAF) cohort. Sociodemographic and clinical characteristics were extracted. Dependency was assessed using the Activities of Daily Living (ADL) scale and cognition using the Mini-Mental State Examination (MMSE) scale. Age, gender, ADL, and MMSE scores were compared with nursing home residents from a twin study of KASAF (n = 332). Results: A total of 107 older adults (mean age 81.8 years; 61.7% women) were recruited in 56 foster families between September 2020 and May 2021. In all, 25.5% had diabetes mellitus and 45.8% suffered from hypertension. The mean MMSE score was 9.3 ± 10.1 and 76.0% had major cognitive impairment (MMSE score <18); 12.5% were diagnosed with Parkinson's disease, and 42.0% of the residents were confined to bed or in a wheelchair, with a mean ADL score of 1.5 ± 1.8. Almost all the residents (96.3%) benefited from a medical follow-up by a nurse who visited once or twice a day. Compared to older adults living in nursing homes, those in foster families were more frequently women (61.7% vs 49.4%) and had lower ADL score (1.5 vs 2.4) and lower MMSE score (9.3 vs 11.3). Discussion and Implications: The clinical profile of foster families' residents was quite similar to that of nursing home residents in terms of demographics, dementia, and dependency. Foster families might represent an interesting strategy to address the unmet clinical and social needs of dependent older adults, especially in countries where nursing homes are not sufficiently developed. Clinical Trials Registration Number: NCT04545775.

The Health Care Trajectories of Older People in Foster Families: Protocol for an Observational Study.

BACKGROUND: With aging of the population, the search for alternative models of care adapted to older people with dependency is necessary. In this setting, foster families (1-3 older people per family) could be an alternative to nursing homes, residential care facilities, or community- and home-based care. OBJECTIVE: The KArukera Study of Ageing in Foster Families is a prospective cohort study designed to investigate the care pathways of older people with dependency in foster care over a year. The 1-year hospitalization rate (main objective), cost of hospitalization, incidence of mortality, prevalence of geriatric syndromes, and quality of life of residents will be assessed. Quality of life and burnout of their respective foster caregivers will also be studied. METHODS: This study cohort will include 250 older people living in foster families in Guadeloupe (French West Indies), as well as their respective foster caregivers. Both older people and caregivers will be interviewed concurrently on site at three time points: (1) at baseline, (2) at 6 months, and (3) at 12 months. For older people, we will collect anthropometric measures, cognitive impairment, depressive and anxiety symptoms, functional abilities, physical frailty, information on general health status, quality of life, and care pathways (hospitalization, mortality, and medical and paramedical consultations). We will also assess the quality of life and burnout symptoms of family caregivers at each follow-up. A phone update of vital status (alive or death) and care pathways of residents will be carried out at 3 and 9 months after the baseline examination. RESULTS: Recruitment opened in September 2020 and ended in May 2021, with 109 older people recruited and 56 respective foster caregivers. The 1-year follow-up was ended in June 2022. Data analyses are ongoing and the first results are expected to be published in May 2023. CONCLUSIONS: Foster families are a potentially innovative way to accommodate dependent older people. This study could help define the clinical profile of older people adapted to foster families in the transition from frailty to dependency. The effectiveness of foster families, in terms of hospitalizations and mortality, will be compared with other models of care, particularly nursing homes. In this setting, a twin study carried out in nursing homes in Guadeloupe with similar aims and outcomes will be conducted. Beyond mortality and morbidity, the numerous outcomes will allow us to assess the evolution of geriatric syndromes over time. TRIAL REGISTRATION: ClinicalTrials.gov NCT04545775; https://clinicaltrials.gov/ct2/show/NCT04545775. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40604.

Família acolhedora: o estabelecimento de relações objetais em situação de acolhimento / Foster family: the establishment of object relations in fostering situation / Familia acogedora: el establecimiento de relaciones de objeto en situación de acogimiento

O serviço de Família Acolhedora organiza o acolhimento de crianças e adolescentes afastados, temporariamente, do convívio familiar. Consideramos pertinente discutir e pensar essa prática para além de seus aspectos jurídicos e assistenciais, mas também científico-acadêmicos e psicológicos. Com o objetivo de compreender o estabelecimento de relações objetais nesse contexto específico, foram entrevistados dois adolescentes e cinco crianças que vivenciam ou vivenciaram essa experiência em algum período de suas vidas. As entrevistas foram não-diretivas e partiu-se de uma questão disparadora que estimulasse os depoimentos e contemplasse o método psicanalítico de associação livre.

The Foster Family Service organizes the fostering of children and adolescents who have been temporarily removed from family life. We consider relevant to discuss and think this practice beyond their legal and assistance aspects, also considering their scientific-academic and psychological characteristics. In order to understand the establishment of object relations in this specific context, we interviewed two teenagers and five children who have been experiencing or have experienced fostering at some period in their lives. The interviews were non-directive and initiated from a triggering question in order to encourage testimonials and free association psychoanalytical method.

El servicio Familia Acogedora organiza el cuidado de los niños y adolescentes retirados temporalmente de la vida familiar. Consideramos relevante discutir y pensar no solo los aspectos jurídicos y asistenciales de esta práctica, sino también científico-académicos y psicológicos. Para comprender el establecimiento de relaciones de objeto en este contexto específico, fueron entrevistados a dos adolescentes y a cinco niños que viven o vivieron esta experiencia en algún momento de sus vidas. Las entrevistas fueron no directivas, y se instaló una pregunta de arranque que estimulase los testimonios y contemplase el método psicoanalítico de la asociación libre.

Família acolhedora: o estabelecimento de relações objetais em situação de acolhimento / Foster family: the establishment of object relations in fostering situation / Familia acogedora: el establecimiento de relaciones de objeto en situación de acogimiento

O serviço de Família Acolhedora organiza o acolhimento de crianças e adolescentes afastados, temporariamente, do convívio familiar. Consideramos pertinente discutir e pensar essa prática para além de seus aspectos jurídicos e assistenciais, mas também científico-acadêmicos e psicológicos. Com o objetivo de compreender o estabelecimento de relações objetais nesse contexto específico, foram entrevistados dois adolescentes e cinco crianças que vivenciam ou vivenciaram essa experiência em algum período de suas vidas. As entrevistas foram não-diretivas e partiu-se de uma questão disparadora que estimulasse os depoimentos e contemplasse o método psicanalítico de associação livre.

The Foster Family Service organizes the fostering of children and adolescents who have been temporarily removed from family life. We consider relevant to discuss and think this practice beyond their legal and assistance aspects, also considering their scientific-academic and psychological characteristics. In order to understand the establishment of object relations in this specific context, we interviewed two teenagers and five children who have been experiencing or have experienced fostering at some period in their lives. The interviews were non-directive and initiated from a triggering question in order to encourage testimonials and free association psychoanalytical method.

El servicio Familia Acogedora organiza el cuidado de los niños y adolescentes retirados temporalmente de la vida familiar. Consideramos relevante discutir y pensar no solo los aspectos jurídicos y asistenciales de esta práctica, sino también científico-académicos y psicológicos. Para comprender el establecimiento de relaciones de objeto en este contexto específico, fueron entrevistados a dos adolescentes y a cinco niños que viven o vivieron esta experiencia en algún momento de sus vidas. Las entrevistas fueron no directivas, y se instaló una pregunta de arranque que estimulase los testimonios y contemplase el método psicoanalítico de la asociación libre.

O mistério do orçamento dos abrigos no Rio de Janeiro / The mystery of from shelters budget in Rio de Janeiro

O presente artigo visa contribuir com os profissionais e militantes da área da infância e juventude nos processos de pactuação e organização política. Objetiva-se demonstrar alguns dados comparativos do orçamento público e das políticas de acolhimento institucional e familiar na cidade do Rio de Janeiro. E, a partir desse breve levantamento, analisar criticamente o peso do orçamento destinado aos abrigos, na política de assistência social, e a lógica da prioridade absoluta de crianças e adolescentes nas políticas públicas.

This article aims to contribute with professionals and activists for children and youths about pact processes and political organization. The objective is to demonstrate some comparative data from the public budget and the policies for institutional and foster care in the city of Rio de Janeiro. And, from this brief survey, to critically analyze the weight of the budget for shelters in social assistance policies, and the logic of absolute priority of children and adolescents in public policies.

Acolhimento familiar: validando e atribuindo sentido às leis protetivas / Foster care: validating and giving sense to the protective laws

No contexto da atual legislação brasileira, no que se refere às crianças e aos adolescentes em situação de vulnerabilidade e risco, vamos encontrar um novo serviço dentre as medidas protetivas previstas: o serviço de acolhimento em família acolhedora. Dado o ineditismo desse serviço como política pública, este artigo tem por objetivo contribuir para a reflexão sobre a sua execução no território nacional.

In the context of the current Brazilian legislation, which refers to children and adolescents in situations of vulnerability and risk, we will find a new service among the protective measures ­provided: host service in welcoming family. Given the unprecedented of this service as a public policy, this article aims to contribute to reflection about its execution in the country.

Acolhimento de crianças e adolescentes em situações de abandono, violência e rupturas / Fostering children and adolescents in situations of abandonment, violence and separation

A proteção integral à infância encontra-se em reordenamento. Baseadas nas experiências do GIAAA-CINDEDI (Grupo de Investigação sobre Abrigamento, Acolhimento Familiar e Adoção - Centro de Investigações sobre Desenvolvimento Humano e Educação Infantil), buscamos compreender a rede de significações que permeia as práticas de acolhimento familiar, institucional e adoção. Investigamos vários contextos e protagonistas: sistema judiciário, abrigos, mães e famílias de origem, de acolhimento e adotivas. Diversos procedimentos foram utilizados: investigações sócio-demográficas, estudos de caso, entrevistas, pesquisa documental nos abrigos e no Fórum, grupos de discussão. Ressaltamos achados comuns: "invisibilidade" da família de origem; freqüente (re)violação da criança; falhas na Rede de Proteção; significações sobre "família saudável" e papel das concepções sobre apego que permeiam o campo. Implicações para políticas públicas e práticas sociais na área são discutidas.

Childhood protection is undergoing several changes. Our study aimed to outline the complex network of meanings which includes adoption as well as institutional and family foster care, by combining theory, research and practice. We investigated various contexts and protagonists: judicial system, foster institutions, birth parents, foster and adoptive parents, and families and their children. Diverse data collection procedures were used: socio-demographic investigations, case-studies, follow-ups, interviews, analysis of foster institutions and legal court documents. Results pointed to "invisibility" of birth family, frequent child (re)abuse, failures in the network of protection, meanings of "healthy family" and role of attachment concepts. Implications for social policies and social practices are discussed.

Acolhimento de crianças e adolescentes em situações de abandono, violência e rupturas / Fostering children and adolescents in situations of abandonment, violence and separation

A proteção integral à infância encontra-se em reordenamento. Baseadas nas experiências do GIAAA-CINDEDI (Grupo de Investigação sobre Abrigamento, Acolhimento Familiar e Adoção - Centro de Investigações sobre Desenvolvimento Humano e Educação Infantil), buscamos compreender a rede de significações que permeia as práticas de acolhimento familiar, institucional e adoção. Investigamos vários contextos e protagonistas: sistema judiciário, abrigos, mães e famílias de origem, de acolhimento e adotivas. Diversos procedimentos foram utilizados: investigações sócio-demográficas, estudos de caso, entrevistas, pesquisa documental nos abrigos e no Fórum, grupos de discussão. Ressaltamos achados comuns: "invisibilidade" da família de origem; freqüente (re)violação da criança; falhas na Rede de Proteção; significações sobre "família saudável" e papel das concepções sobre apego que permeiam o campo. Implicações para políticas públicas e práticas sociais na área são discutidas.(AU)

Childhood protection is undergoing several changes. Our study aimed to outline the complex network of meanings which includes adoption as well as institutional and family foster care, by combining theory, research and practice. We investigated various contexts and protagonists: judicial system, foster institutions, birth parents, foster and adoptive parents, and families and their children. Diverse data collection procedures were used: socio-demographic investigations, case-studies, follow-ups, interviews, analysis of foster institutions and legal court documents. Results pointed to "invisibility" of birth family, frequent child (re)abuse, failures in the network of protection, meanings of "healthy family" and role of attachment concepts. Implications for social policies and social practices are discussed.(AU)