Showing papers in "Health & Social Work in 2006"

An Examination of the Social Networks and Social Isolation in Older and Younger Adults Living with HIV/AIDS.

Abstract: This study examined social networks and social isolation in older (50 years or more) and younger (ages 20 to 39) adults with HIV/AIDS The author conducted interviews with 88 individuals living with HIV/AIDS in the Pacific Northwest Both groups' social networks had similar patterns; however, older adults were more likely to live alone More than 38 percent of older adults and 54 percent of older adults of color were at risk of social isolation compared with 25 percent of those 20 to 39 years of age Older men and older adults of color had significantly lower scores on the social network scale than others Having a confidant and receiving instrumental support were significantly correlated with reduced HIV stigma Implications for social work practitioners are discussed

Do Not Forget about Your Volunteers: A Qualitative Analysis of Factors Influencing Volunteer Turnover

Abstract: The number of individuals who share their time and talents as volunteers is on the rise. In 1993 it was reported that formal volunteer work was performed by 89.2 million Americans, worth an estimated $182.3 billion (Grube & Piliavin, 2000). In particular, most hospitals rely on volunteers to complete a multitude of tasks that both the clinical and the administrative staff cannot fit into their schedules. Those individuals who manage and oversee volunteer programs face a twofold challenge: orienting, training, and monitoring volunteers as well as retaining these volunteers (Forsyth, 1999). There appears to be a cause and effect relationship between these two facets of volunteer program development. An effective orientation and training of a program's volunteers will engage participants in a way that results in volunteers' willingness to participate in the agency's volunteer program for a significant period of time. However, if there is a breakdown in one of these functions, it is not long before an organization's volunteer program starts to flounder. REVIEW OF RELEVANT LITERATURE From the moment a program trains a group of volunteers, the focus should be on retention. Lynch (2000) stated that volunteer retention, in its simplest form, is making volunteers feel good about their assignment and themselves. If the volunteer experience makes the volunteers feel good, then they will continue to want to volunteer (McCurley & Lynch, 1996). Shanti National Training Institute, an organization that serves people who work as leaders of volunteers, identifies a number of factors that influence volunteer retention, including the quality and thoroughness of the initial training experience, the effectiveness of volunteer management, and the degree of personal satisfaction achieved through volunteering (www.shanti.org/ snti/retention.html). Retention has an evil twin: turnover, or the number of volunteers who leave the organization that have to be replaced. Retention and turnover are important variables to volunteer program managers because they present serious problems for organizations that depend on volunteers to execute their mission statement. Although volunteer turnover is to be expected in volunteer organizations and creates opportunities for organizational change, high rates of turnover can hinder the capacity of organizations to deliver the quality or range of services and programs clients come to expect (Razzak, 2001). In addition, high turnover rates are critical when there is a need for volunteers with special skills or intensive training; volunteer responsibilities that require long-term commitments; the clients served by volunteers are disrupted by the absence of volunteers; and there is a shortage of qualified volunteers (Wymer & Starnes, 2001). According to McCurley and Lynch (1996), studies of volunteer retention have determined that the first six months of volunteers' experience is critical toward their retention, as the greatest loss of volunteers occurs during this period. Wymer and Starnes (2001) have constructed a two-part life cycle of volunteerism that provides insight into when a large portion of volunteers depart from their commitment to the agency. Volunteers start their service in a "honeymoon" stage, which is composed of euphoria, self-congratulation, and eagerness to give of themselves. Upon gaining some experience, volunteers regress to a "post-honeymoon blues" phase. The idealism motivating their initial endeavor has now dissipated. This regression may occur when volunteers realize they are not able to accomplish what they had initially anticipated or when they realize that the organization does not represent the values or issues they originally thought. Such realizations put a damper on an individual's initial motivating forces, and it merely becomes a matter of time before the volunteer steps out of the role of servitude. Volunteers also require more attention at "anniversaries," at the end of large projects, or at the completion of an agreed term of participation (McCurley & Lynch, 1996). …

Psychosocial Outcomes for Adult Children of Parents with Severe Mental Illnesses: Demographic and Clinical History Predictors

Abstract: Children of parents with mental illness are at risk of psychiatric and behavioral problems. Few studies have investigated the psychosocial outcomes of these children in adulthood or the parental psychiatric history variables that predict resilience. From a sample of 379 mothers with serious mental illnesses, 157 women who had at least one adult child between the ages of 18 and 30 were interviewed. Mothers reported that about 80 percent of these adult children were working, in school, or in training. However, about one-third had not completed high school, and 54 percent were judged to have a major problem in psychological, drug or alcohol, or legal domains. Although nearly 40 percent were parents of minor children, only about 12 percent were in a committed relationship. Mothers' bipolar diagnosis was a significant predictor for number of adult child problems. The results indicate a need for more attention to the parenting status of adults with mental illnesses and to their parenting concerns and needs.

Fostering Resilience in Siblings of Youths with a Chronic Health Condition: A Review of the Literature

Abstract: An accumulating body of literature points to the potential for successful outcomes among families who have a child with a chronic health condition. Resilience research has catalyzed a reconceptualization of the experience of such families from a deficit, pathological perspective to a growth-enhancing opportunity. However, scant data available about the specific risk and protective mechanisms influencing the psychosocial outcomes of well siblings in these families are lacking. This article draws on the literature addressing resilience in youths experiencing adversity to inform social workers about how to better promote positive outcomes among well siblings. Implications for future research and suggestions for social work practice to target the unique needs of well siblings are discussed.

Effectiveness of a Care Coordination Model for Stroke Survivors: A Randomized Study

Abstract: This study evaluated the effectiveness of systematically integrating biopsychosocial interventions with coordinated delivery of care for outpatients recovering from stroke. Care coordination coordinates resources across the health care system and routinely addresses the psychological and social risks affecting patient outcomes, while monitoring patient progress. A randomized pre-post comparison group design evaluated the model's effectiveness with 28 patients (16 intervention group; 12 control group) over a three-month period. The model's effectiveness was evaluated by monitoring changes in patient quality of life, patient depression, patient psychosocial functioning, and patient adherence to self-care and in meeting patient service needs. Repeated-measures ANOVA showed significant improvement for the intervention group in mental quality of life, depressive symptoms, and adherence to self-care practices. This study provides preliminary data that a standardized, problem-solving care coordination model can improve patient care.

Breast Cancer Screening: Cultural Beliefs and Diverse Populations

Abstract: This article addresses the role of culture in breast cancer screening behavior among African American, American Indian/Alaskan Native, Asian American/Pacific Islander, and Hispanic/ Latina women. It reviews cultural beliefs, attitudes, and knowledge and their relative influence on women's decisions regarding health tests. The article explores how to build on these cultural values, simultaneously mediating their barrier effects. Building on cultural explanatory models of health behavior, suggestions for incorporating culture into early detection strategies for ethnically and racially diverse, underserved women are provided. In addition, the article offers four practice principles that can be used with all of the groups: inclusion and use of indigenous support; cross-application of approaches for diverse populations; honor and incorporation of culture; and attention to language, literacy, and cultural information.

Men's Adjustment to Their Partners' Breast Cancer: A Dyadic Coping Perspective.

Abstract: The continuing increase in cancer rates among women in the United States is forcing more men to experience the impact of breast cancer on their relationships. Using 71 male partners of newly diagnosed breast cancer patients, this study assessed how dyadic coping strategies affected men's adjustment to their partners' illness. While their partners were undergoing treatment, participants completed standardized instruments that measured emotional well-being, illness intrusiveness, and dyadic coping styles. Regression analysis revealed significant associations between coping styles and illness intrusiveness. In addition, depression predisposed men to poorer adjustment and affected their coping patterns. The findings emphasize that social workers must work with patients and partners to develop positive couple coping strategies. Practice implications for social workers are addressed.

Social Workers in the Substance Abuse Treatment Field: A Snapshot of Service Activities

Abstract: The impact of substance abuse on society is wide ranging and costly. According to a Robert Wood Johnson Foundation (RWJF, 2001) report, substance abuse, including tobacco use, is the cause of more deaths, illnesses, and disabilities than any other preventable health condition. This same report indicates that approximately 25 percent of the more than 2 million deaths each year in the United States are attributable to alcohol, illicit drugs, or tobacco. The Department of Health and Human Services (HHS) estimates that drug and alcohol abuse contribute to more than 120,000 deaths in the United States each year (HHS, 2002). According to Healthy People 2010 (HHS, 2000), alcohol and illicit drug use are associated with a wide range of health and social welfare problems, including child and spousal abuse, sexually transmitted diseases, teenage pregnancy, school failure, motor vehicle crashes, low worker productivity, increasing health care costs, and homelessness. Furthermore, long-term heavy alcohol use can lead to heart disease, cancer, liver disease, pancreatitis, and fetal alcohol syndrome (HHS, 2000). In 1995 the cost of alcohol and drug abuse to society was conservatively estimated at more than $275 billion per year (RWJE 2001). These figures reflect costs associated with illness, deaths, medical care, crime, other related costs (for example, motor vehicle crashes), and special conditions related to substance abuse (for example, HIV/AIDS attributable to substance abuse). According to a Substance Abuse and Mental Health Services Administration (SAMHSA) report, it is estimated that 18 to 26 million Americans were in need of substance abuse treatment in 2002 (SAMHSA, 2003). The 2002 National Survey on Drug Use and Health estimated that 22 million people age 12 or older were classified with substance abuse or dependence, supporting the need for substance abuse treatment in the United States. Estimates from SAMHSA indicate that the need for substance abuse services for individuals with an illicit drug problem are increasing (SAMHSA, 2002a). Furthermore, abuse of alcohol and drugs (both legal and illicit) affects nearly 17 percent of adults age 60 or older (SAMHSA, 2002b). Although the need for treatment is documented, it is estimated that only 3 million people actually received substance abuse treatment in 2002 (SAMHSA, 2003). Literature Review: The Role of Social Workers A Bureau of Labor Statistics (BLS) report indicates that there were 477,000 social work positions in 2002 (BLS, 2004). Of these positions, 95,000 were in mental health and substance abuse. A 1993 HHS report suggested that only 6 percent of all staff in substance abuse treatment programs in the United States were social workers at the master's level or higher. According to the BLS report, employment of social workers is expected to increase faster than the average for all occupations through 2012, and employment of social workers in substance abuse settings will grow rapidly between 2002 and 2012 (BLS).This projected increase is due to a variety of factors, including placement of substance abusers, particularly abusers of illicit drugs, into substance abuse treatment programs instead of into the criminal justice system; recognition of the need to provide substance abuse treatment in the United States; and increased comorbidity of substance abuse disorders with other problems (for example, mental health disorders, HIV/AIDS and other sexually transmitted diseases, child welfare cases). For instance, Hall and colleagues (2000) found that at least half of all hospitalized patients in urban areas have substance abuse--related problems. Often, social workers are the first service providers to come in contact with substance abusers in the various service delivery systems, including child welfare, employee assistance programs, hospitals, schools, programs for elderly people, and community-based services. Social workers often provide key assessment and referral services in an array of health and mental health care settings (Hall et al. …

Health Care for Women with Disabilities: Population-Based Evidence of Disparities

Abstract: The decades prior to the 1990s were notable for the paucity of research conducted on women's health and health care (Public Health Service Task Force on Women's Health Issues, 1985). Concerns about these critical deficits eventually led the National Institutes of Health to create the Women's Health Initiative (Pinn & LaRosa, 1992). Despite these advances, attention to women's health has generally excluded consideration of women with disabilities (Krotoski, Nosek, & Turk, 1996). The dearth of extant research that has examined the health care needs of women with disabilities indicates the critical need for more research targeting this significant, but often overlooked, percentage of the population. In 1995 females with disabilities (defined as having functional limitations in daily living activities) were estimated at nearly 29 million, or 21 percent of the female population (Jans & Stoddard, 1999). Poverty is a compounding factor for women with disabilities, with more than one-third of women with disabilities and 41 percent of women with severe disabilities reported as living in poverty (Jans & Stoddard, 1999), among the highest rates of any subgroup in the United States. More than half of formerly employed women with disabilities reported income below 150 percent of the federal poverty line for 1991 (Haveman, Holden, Wolfe, Smith, & Wilson, 2000). Thus, women with disabilities appear to be at double jeopardy for having worse health outcomes because both their impairments and greater likelihood of being poor put them at increased health risk. RESEARCH ON HEALTH CARE ACCESS Defining Access The Institute of Medicine (1998) defined health care access as the timely utilization of services to achieve the best possible health. Access includes both the potential for obtaining appropriate health care services (potential access), and the actual use of such services, or realized access (Aday & Andersen, 1981, 1984). Researchers have used an array of indicators to measure the multidimensional construct of access, including health insurance coverage, receipt of appropriate preventive counseling, having a usual source of care, number of doctor visits, well-child care, breast exams, and Pap smear tests (U.S. Department of Health and Human Services [HHS], 2000). Satisfaction with care has also been identified as an important factor in predicting health outcomes (HHS, 2000). Barriers to receipt of satisfactory care occur at the personal, clinical encounter, and health care system levels. These barriers are especially significant for people with disabilities, who have more interaction with and increased need for appropriate and accessible health care services (Iezzoni, McCarthy, Davis, & Siebens, 2000). Federal initiatives are attempting to address a number of disparities in the services received by people with disabilities, including health care (HHS, 2001, 2002; Health Resources and Services Administration, 2001). Healthy People 2010, the comprehensive national public health strategy, established goals of preventing secondary medical conditions of people with disabilities and eliminating health care disparities between disabled and nondisabled people (HHS, 2000). However, the inadequate knowledge base regarding disabled people's health care experiences is revealed by the fact that baseline data were unavailable for more than half the 207 objectives related to people with disabilities in Healthy People 2010 (HHS, 2000). Research on Health Care Access and People with Disabilities In general, research conducted on health care for people with disabilities has fallen into three categories: single-impairment studies, qualitative investigations, and large, nationally representative surveys. Although researchers have used different methodological approaches, this body of research is still in its infancy compared with the extensive analyses that have described race-based health disparities in the United States (Collins, Hall, & Neuhaus, 1999). …

The Clubhouse as an Empowering Setting

Abstract: Attention to psychosocial rehabilitation (PSR) practice has expanded in recent years. However, social work research studies on PSR are not numerous. This study focuses on operational characteristics of clubhouses, a major PSR program model, and the organizational attributes (including resource levels) that predict the extent to which the clubhouse constitutes an empowering setting. The authors present data from a statewide sample of 30 clubhouses, annually serving nearly 4,000 consumers (adults with serious mental illnesses), based on interviews of clubhouse directors, on-site observations, and government information sources. Results indicate that users were predominantly male, white, and middle age; about one-third had a major functional disability. There were wide variations in member characteristics as well as in resource levels. In terms of empowerment, this sample of clubs averaged rather low levels of member involvement in governance and operations but seemed to provide members with opportunities and assistance in making their own decisions. The empowerment variables had different predictors, including client characteristics, urban-related characteristics, staffing, and resource levels. Implications for social work practice in PSR settings are discussed.

First-Birth Outcomes and Timing of Second Births: A Statewide Case Management Program for Adolescent Mothers

Abstract: Adolescent pregnancy is often associated with an increased likelihood of inadequate prenatal care and poor birth outcomes, such as low birthweight and premature birth (Fraser, Brockert, & Ward, 1995; Leland, Petersen, Braddock, & Alexander, 1995; Wiemann, Berenson, Garciadel Pino, & McCombs, 1997) Inadequate prenatal care may likely contribute to a higher risk of poor birth outcomes, and in effect, poor birth outcomes are associated with an increased risk of infant mortality or developmental and health problems throughout the child's life (Hack, Klein, & Taylor, 1995; Leland et al) Maternal factors, such as young maternal age, race, marital status, and tobacco use during pregnancy may affect use of prenatal care and birth outcomes Several studies indicate that teenage mothers do not obtain prenatal services or tend to delay initiation of prenatal care (Leland et al, 1995; Wiemann et al, 1997) Furthermore, a teenage mother's young gynecologic age could have a role in increasing the risk of poor birth outcomes (Abel, 1997; Fraser et al, 1995) Black teenage mothers have been found at increased risk of inadequate prenatal care, low birthweight, and preterm births (Chang, O'Brien, Nathanson, Mancini, & Witter, 2003; Leland et al;Wiemann et al) Unmarried mothers are more likely to have poor prenatal care utilization and higher rates of low birthweight babies than those who are married (Abel) Tobacco use during pregnancy also increases the risk of low birthweight and preterm births (Cornelius, Taylor, Geva, & Day, 1995) Postponing a second birth and having adequate spacing between pregnancies are crucial for teenage mothers In general, a short interpregnancy interval is viewed as a risk factor for poor birth outcomesAn interval of about 18 to 23 months is considered vital to restore maternal nutritional resources and for alleviation of postpartum stress (Klerman, Cliver, & Goldenberg, 1998) Approximately 30 percent to 50 percent of adolescent mothers whose first birth occurred before age 18 have a second birth within 12 to 24 months (Coard, Nitz, & Felice, 2000) Teenage mothers who have subsequent births within two years face an even greater risk of poor birth outcomes than first-time teenage mothers For example, Blankson and colleagues (1993) found that adolescents with a poor outcome during their first pregnancy had at least a three-fold risk of repeating that poor outcome Furthermore, teenage mothers who have subsequent births during their teenage years are more likely to have lower levels of educational attainment and to live in poverty or receive welfare than mothers who have one child during adolescence (Dailard, 2000; Manlove, Mariner, & Papillo, 2000) Studies that examine the use of prenatal care and birth outcomes of participants of adolescent pregnancy and parenting programs are generally outgrowths of interventions that provide support services in health care settings, such as hospitals or clinics (Covington, Peoples-Sheps, Buescher, Bennett, & Paul, 1998; Rogers, Peoples-Sheps, & Suchindran, 1996; Stevens-Simon, Nelligan, & Kelly, 2001) These interventions tend to involve home visiting services provided by public health nurses or paraprofessionals Many programs for pregnant and parenting adolescents have long existed in other settings, such as in community agencies, social services, and schools, however These programs often include case management with a range of service components provided by social workers and health service professionals (Barnet, Duggan, & Devoe, 2003; Granger & Cytron, 1999; Key, Barbosa, & Owens, 2001; Philliber, Brooks, Lehrer, Oakley, & Waggoner, 2003; Solomon & Liefeld, 1998) Because community, social services, or school-based case management programs rarely have access to health data, studies of their effectiveness tend to focus more on adolescent mothers' social outcomes (for example, education, economic self-sufficiency, and subsequent births) and less on their prenatal care utilization and birth outcomes …

End-of-Life Decision Making for Nursing Home Residents with Dementia: A Survey of Nursing Home Social Services Staff.

Abstract: The purpose of this survey was to describe nursing home social services staff roles and perceptions related to end-of-life medical decision making for nursing home residents in endstage dementia. Using a self-designed questionnaire, 138 nursing home social services staff from across New York State answered questions about advance directives, medical interventions, and comfort levels with withholding and withdrawing of treatment. Results showed a high degree of involvement in advance directive discussions, problems in the implementation of advance directives, and wide variation in comfort levels with treatment issues. Results of this study indicate areas of need for further research and training of nursing home social services staff.

Race Disparities in Health among Older Adults: Examining the Role of Productive Engagement

Abstract: Race differences in morbidity and mortality are visible across the life course and persist well into later life. Individuals who are members of some minority groups face the prospects of shorter life expectancies, poorer health outcomes at all ages, and longer periods of chronic disease and disability at the end of life. These disparities have given rise to intensive research seeking to determine their causal pathways and develop interventions. Health inequalities by race have been found to result from variations in socioeconomic status (SES) (Hayward, Crimmins, Milies, & Yang, 2000), social context (Waite & Hughes, 1999), community-level factors (Robert & Lee, 2003), social activity (Clark & Maddox, 1992), health behavior (Berrigan, Dodd, Troiano, Krebs-Smith, & Barbash, 2003), and the complex interactions among these factors (Williams, 2002). Productive engagement--that is, paid and unpaid involvement in activity producing goods or services--is likewise shaped by social and cultural forces that differentially act on individuals based on gender, age, and race (Hinterlong, Morrow-Howell, & Sherraden, 2001). It also exhibits a positive relationship to physical health and mortality (Glass, Mendes de Leon, Marottoli, & Berkman, 1999). Yet, its contribution to health disparities has been infrequently considered. This is the first study to explore how the functional status and self-rated health of older African American and white adults relate to productive engagement. RACE AND PRODUCTIVE ENGAGEMENT The relevance of race to productive engagement is best considered from a life course perspective. Productive activity occurs commonly in the context of social roles, such as that of paid worker, caregiver, or unpaid volunteer, which individuals manage as role sets. Late-life role sets are shaped by an array of social and cultural forces that influence individual behavior (Hill & Sandford, 1995). For example, caregiving displaces paid work more frequently for women than men throughout the life course. Similarly, cascading or cumulative disadvantages, such as racial discrimination and dominant norms, create increasingly unequal access to productive roles for African American and white individuals (Dannefer, 2003). For instance, evidence shows that race affects the range of volunteer and paid work opportunities available to individuals. From a life course perspective, health disparities research conducted among older adults heightens the salience of these forces because age is a proxy for exposure to social and material conditions that differentially affect individuals on the basis of race (Geronimus, 1992). This study was motivated by the assumption that these forces create racial differences in productive engagement that then act on pathways to health disparities such as power, SES, work conditions, and health care access (Williams & Collins, 1995). Racial differences in productive engagement are seen across types of roles, levels (hours) of performance, and activity patterns. Older African Americans are more likely to undertake formal paid employment (National Academy on an Aging Society, 2000), and less likely to volunteer (Independent Sector, 2000), but are equally likely to be caregivers compared with white adults (Alecxih, Zeruld, & Olearczyl, 2001). Irregular employment (Jackson, 2001) and informal social assistance (Navaie-Waliser et al., 2001) are more prevalent among older African Americans. Glass and colleagues (1995) found that elderly black people were more likely to increase their level of productive activity over time compared with white individuals. CONNECTING PRODUCTIVE ENGAGEMENT AND HEALTH Engagement is important to late-life well-being (Rowe & Kahn, 1998). Recent evidence shows that productive engagement specifically exhibits a significant, salutary connection to health (Everard, Lach, Fisher, & Baum, 2000; Rozario, Morrow-Howell, & Hinterlong, 2004) and mortality (Glass et al. …

Worries of the Oldest-Old

Abstract: With the emerging population of the oldest-old (those ages 85 and older), it is crucial to understand and prepare for their psychosocial needs. Worry is linked to psychological well-being and physical health, but little is known about the oldest-old's everyday worries. The authors explored four research questions: (1)What are the worries of the oldest-old? (2)What are their specific dimensions of worry? (3) How alike or different are the worry patterns over time? (4) What factors are related to variations in the pattern of change in worry? A convenience sample of 193 community-dwelling people ages 85 and older was recruited to examine various aspects of health and well-being between 1986 and 1995. This article reports on the survivors (N = 23) across three time points, waves 1,4, and 5. The findings suggest that the very old mainly worry about health and memory and that, although worry increased over the study period, there were variations in the pattern of worry over time. Results of t tests show that at wave 4 elderly respondents with a higher level of worry reported more frequent social contact than those with a lower level of worry. Implications for social work practice and future research are discussed. KEY WORDS: oldest-old; social support; very old; worry ********** Little is known about the lives of those who are very old, in particular, their everyday worries. Worry is among the more prevalent psychological conditions that people experience at all ages (Carmin, Pollard, & Gillock, 1999), conveying negative thinking about future events (Babcock, Laguna, Laguna, & Urusky, 2000), and it is associated with mental and physical well-being (Skarborn & Nicki, 1996; Wisocki, 1988; Wisocki, Handen, & Morse, 1986). With many very old people facing diminishing physical and social resources, as well as uncertain futures because of advanced age, it would seem that they could have many things to worry about, but it is unclear what their worries are, what specifically contributes to them, and if these worries increase with advancing age. Most of the work exploring everyday worry has focused on young adults, but in recent years the topic of worry has emerged as a research area of interest among elderly people (Cappeliez, 1989; Powers, Wisocki, & Whitbourne, 1992; Skarborn & Nicki, 1996; Wisocki, 1988; Wisocki et al., 1986). Research findings show there is age variation in degree of worry as well as content of worry. In general, older adults are relatively less worried than younger adults (Babcock et al., 2000; Powers et al., 1992). Babcock and associates suggested that there are a variety of reasons for this age variation. Younger adults are developmentally in a transition stage that may cause greater reason to worry. Older adults may be less willing to acknowledge problems dealing with stressful events and less likely to be in a state of ambiguity about their future. Also, older adults tend to experience various stressful situations as they age. Over time, elderly people might have learned better coping strategies to deal with worry more effectively, resulting in less worry than their younger counterparts. Research findings have also suggested that there are age differences in what people worry about. Powers and colleagues (1992) found that older adults expressed less worry about finances and social events than younger adults, whereas both age groups worried about health issues, although the specific dimensions of health were not identified. Similarly, Babcock and associates (2000) found that younger adults were more worried than older adults about work, relationships, and finances. Less is known about degree of worry and content of worry among the oldest-old. A study examining worry among the oldest-old reported that the greatest worries among oldest-old subjects were related to their health and functioning, such as concerns about falls, not having enough energy, or forgetting things (Dunkle, Roberts, & Haug, 2001). …

Baby Think It Over: Evaluation of an Infant Simulation Intervention for Adolescent Pregnancy Prevention

Abstract: In an intervention aimed at showing students the amount of responsibility involved in caring for an infant, 353 predominantly ninth-grade and Latino students carried the Baby Think It Over simulation doll in an intervention and completed matched pre- and posttest measures. Statistically significant gains were found on the total score and the impact of having a baby on academics, social life, and other family members; emotional risks; understanding and handling an infant's crying; and apprehension of the amount of responsibility involved in infant care. On a posttest-only measure, 108 participants reported statistically significant differences before and after carrying the doll with regard to the age at which they wished to have a child, their career and education plans, and the perceived interference of an infant with those education and career plans and their social life.

The Silent Thief: Osteoporosis and Women's Health Care across the Life Span

Abstract: Osteoporosis is a skeletal disease characterized by loss of bone mass and density, which results in an increased risk of fractures. The disease is referred to as the "silent thief," because it is often not until a person falls and breaks a bone that patients and their physicians become aware of weakening bones. An estimated 1.5 million bone fractures occur each year in the United States and cost nearly dollar 17 billion in health care costs and lost productivity. The perception that osteoporosis is an older person's disease is an erroneous one. Osteoporosis does not discriminate by age; in fact, it is a geriatric disease with an adolescent onset. Social workers in health care and other practice settings working with female clients across the life span are in prime positions to influence patient outcomes and reduce health care costs by raising awareness of the risk factors and complex biopsychosocial aspects of this debilitating disease. This article presents social work interventions within the conceptual framework of primary, secondary, and tertiary disease prevention.

A Community Capacity-Enhancement Approach to Breast and Cervical Cancer Screening among Older Women of Color

Abstract: In the Screening Older Minority Women project, the authors applied a community capacity-enhancement approach to promoting breast and cervical cancer screening among older women of color. Members of informal support networks were recruited for this health promotion intervention to empower Latina and African American women to engage in positive health behaviors. The authors describe the phases of the intervention and the experiences from the community. Guidelines are identified to help researchers and practitioners in planning and implementing community health promotion intervention with women of color.

A Survey of the Health, Sleep, and Development of Children Adopted from China

Abstract: International adoption is an increasingly popular method for parents seeking to increase the size of their families. For example, Arsonson (2003) reported that there were more than 15,000 international adoptions in the United States in 1998. This was an increase of more than 2,000 from 1997. One of the main sources of international adoption is China. According to the National Adoption Information Clearinghouse (2003), there have been more than 32,000 visas issued for children being adopted from China since 1995. Given the large number of children coming to this country from China and the general concerns about the psychological and behavioral impact of adoption, it is reasonable to investigate health and developmental outcomes after the adoption. Information on the postadoptive outcomes of children adopted from China is relevant to social workers, adoption agencies, and other professionals assisting families with international adoption. It is important that these professionals be aware of any potential problems so that families can be prepared for possible child care issues. For example, Shapiro and colleagues (2001) indicated that studies of children of international adoption have shown potential problems with psychological adjustment. These problems may be due to medical or nutritional deprivation, lack of a primary caregiver, or inconsistencies in caregivers. Howe (1997) noted that nearly 25 percent of adopted children will display some type of behavioral or mental health concern later in life, so it is important to be aware of postadoptive outcomes. RELATED LITERATURE We conducted a search for relevant literature using ERIC and Internet search engines. This search focused on studies relevant to children adopted from China and for reports investigating health, sleep, or developmental problems. Several reports relevant to this investigation were identified. One potential area of concern regarding international adoptions involves medical concerns. Arsonson (2003), for example, identified and discussed 17 potential medical problems, including malnutrition, rickets, eczema, scabies, lead poisoning, bacterial intestinal infections, tuberculosis, hepatitis B and C, asthma, anemia, and visual or hearing problems. Despite the relatively large number of potential medical problems, Aronson noted that the children typically have limited long-term medical issues and that these are fairly easily addressed with diagnosis and proper treatment. Another potential area of concern involves the fact that earlier research has indicated that it is typical for children to present with developmental delays at the time of their adoption (Johnson & Traister, 1999; Miller & Hendrie, 2000; Miller, Kiernan, Mathers, & Klein-Gitelman, 1995). In the Miller and associates study, the mean age of children at arrival was 14 months, and they were seen within three months of arrival. These researchers found that approximately 74 percent of children showed delays in one or more areas of development at the time of their arrival in the United States. Miller and Hendrie assessed the health and developmental status of 452 children in two different groups. Of the 452 children, 98 percent were girls. They found that 75 percent of the children had significant developmental delays in at least one area and that the delays were related to length of time children spent in orphanages. The longer the time spent in an orphanage, the greater the developmental delays. Delays in gross motor skills were most common (55 percent), followed by delays in language (43 percent), socioemotional (28 percent), and cognitive skills (32 percent). Miller and Hendrie also found that a number of children had medical problems, including anemia (35 percent), elevated lead levels (14 percent), tuberculosis (3.5 percent), and hepatitis B surface antibody (22 percent). Each of these studies pointed to the need for continued long-term follow-up of the children. …

Organizational Characteristics Influencing Nursing Home Social Service Directors' Qualifications: A National Study

Abstract: This research sought to identify organizational characteristics associated with the amount of professional qualifications among a nationally representative sample of nursing home social service directors. A self-administered survey was sent to directors in 675 facilities randomly sampled from a federal database, excluding facilities with fewer than 120 beds that are not required to staff a full-time social worker. The response rate was 45 percent (N = 299). Univariate results showed that most respondents possessed a social work degree, most lacked licensure, and few were clinically supervised. A multiple regression analysis found that nonprofit, independently owned facilities in rural areas staffed social service directors who were significantly more qualified than directors in for-profit, chain-affiliated facilities in urban and suburban areas. Facilities with fewer psychosocial deficiencies and higher occupancy rates employed social service directors with greater qualifications. The implications of these findings for social work education, practice, policy, and research are discussed. KEY WORDS: nursing homes; professional qualifications; professionalization; social service directors ********** Nursing home (NH) residents, among the most vulnerable members of our society, typically have complex, interacting psychosocial and medical needs. Most require extensive assistance with personal care, including bathing, dressing, toileting, eating, and transfers (Jones, 2002), and nearly 75 percent have cognitive impairment, often complicated by depression, agitation, or both symptoms (Bartels et al., 2003). Social workers are commonly the primary staff assigned to psychosocial services provision--assessing, monitoring, and either providing or referring residents and their families for needed clinical or support services. Therefore, they also are key providers and facilitators of mental health services in the home. Current federal regulations require the provision of medically related social services in all nursing homes certified for Medicare or Medicaid payments, although only facilities with more than 120 beds are required to employ a full-time social worker who possesses the minimum of a bachelor's degree in social work or "similar professional qualifications" (Nursing Home Reform Act, 1987). This federal definition of a social worker varies from professional standards (National Association of Social Workers [NASW], 2003) by allowing staff who lack degrees in social work and may not have basic practice knowledge and skills to serve in this role. It also erodes social work's professional status in NHs given Greenwood's (1957) characterization of professions as possessing a body of knowledge, authority and expertise, a code of ethics, a culture that includes self-monitoring, and public sanctioning. Perhaps the most salient concern, public sanctioning allows for title protection, accreditation of educational programs, and a licensing system and requires professionals to convince their communities, and likely their employers, that their skills and performance require specialized education and lead to good outcomes for clients. Historically, the process of social work professionalization may have contributed to a deprofessionalization of the public welfare workforce, because social work failed to "define its domain of activity ... to establish and protect its border and to assert its professional authority in the context of services for the poor and dependent" (Lowe & Reid, 1999, p. 91). Although not typically viewed as part of the modern-day public welfare system, NHs might very well fit into this spectrum as most residents are frail and impoverished and must rely on Medicaid to cover the cost of their room and board. Concerns about a perceived lack of training among social services providers and, specifically, the use of social work designees (that is, staff lacking training in social work) in NHs culminated in a formal complaint to the U. …

Significance of Gender and Age in African American Children's Response to Parental Victimization

Abstract: This study examined gender and age differences in children's psychological response to parental victimization in a convenience sample of African American children. Thirty youths, ages six to 12, whose parents had been a victim of community violence (that is, gunshot or stabbing), and a control group of 30 children matched on variables of race, age, gender, and neighborhood served as the sample for this study. Parents completed a demographics sheet and the Child Behavior Checklist. Data were collected within six weeks of parental victimization. No significant difference was found in male and female youths' internalizing and externalizing behavior at ages six to eight. However, beginning at age nine there was a significant difference in behavior. Youths exposed to parental victimization internalized and externalized to a greater degree than those children who were not exposed. Males externalized more than females, and females internalized more than males. Thus, the perceived trauma response may vary as a function of the child's gender and developmental level or age. These findings suggest that gender-specific response related to trauma exposure may begin as early as age nine. Language: en

Functional Limitations and Religious Service Attendance among African American and White Older Adults

Abstract: Church attendance is associated with improved health and well-being among older adults, but older adults with functional limitations may have difficulty attending church services. This article examines differences in the association between functional limitations and church attendance in a sample of 987 elderly African American and white individuals. African American and white elderly people without limitations attended church at virtually the same rate (69 percent). Despite their higher scores on religiousness measures, elderly African Americans with one or more limitations were significantly less likely to attend church regularly than were white counterparts. Health status measures did not help explain older African Americans' lower attendance rates. Differences in attendance were associated primarily with educational attainment and cognitive functioning. The article recommends social work intervention to reduce barriers to church attendance for older adults who want to attend services. KEY WORDS: African Americans; church attendance; elderly people; functional limitations ********** Religious participation and activities are positive resources for many older adults in solving problems and dealing with difficult life issues (Barusch, 1999; Cutler & Hendricks, 2000). There is evidence that religious participation is of particular importance for elderly African Americans (Black, 1999; Chatters T McFadden, 1996; Neill & Kahn, 1999) and may be of particular importance for older adults in poor health (Idler & Kasl, 1997). Research has also indicated that older adults with health limitations, people who could potentially benefit substantially from the fellowship and inspirational experiences that religious service attendance can provide, may find that their low functional status makes religious service attendance difficult (Idler, 1987; Koenig, 2002).Thus, some have recommended that social workers help elderly individuals who want to be active in their faith communities to attend religious services and other activities (McInnis-Dittrich, 2002). The purpose of this study was to determine whether there were differences in the extent to which functional impairments affected religious service attendance among elderly African American and white community-dwellers. If such impairments affected African American and white older adults' religious service attendance differently, the study's second aim was to understand the reasons for these differences. Understanding such differences can help practitioners design more effective, evidence-based intervention strategies that are spiritually and racially sensitive to their clients' needs. Many studies have found positive associations between religious service attendance and better health (see Koenig, McCullough, & Larson, 2001, for a review). Researchers have reported these salutary effects in both studies of elderly African American and white people (Roff et al., 2004) and studies of African American older adults alone (Levin, Chatters, & Taylor, 1995). Several explanations link religious service attendance and better health. Krause (2002) pointed to the spiritual and emotional support elders receive from those in their congregations as well as to the optimism that churchgoers feel because of a close relationship with God. Service attendance may also contribute to good health because it promotes good health behaviors (Roff et al., 2005; Strawbridge, Shema, Cohen, & Kaplan, 2001). For many, religious participation is a critical component of successful aging (Crowther, Parker, Achenbaum, Larimore, & Koenig, 2002). Idler and Kasl (1997) suggested that religious service attendance is especially important for the well-being of adults with health limitations. …

Saving Grace: a breast cancer prevention program in the African American community.

Abstract: A solution to get the problem off, have you found it? Really? What kind of solution do you resolve the problem? From what sources? Well, there are so many questions that we utter every day. No matter how you will get the solution, it will mean better. You can take the reference from some books. And the saving grace a breast cancer prevention program in the african american community is one book that we really recommend you to read, to get more solutions in solving this problem.

An Innovative Community-Based Intervention for African American Women with Breast Cancer: The Witness Project®

Abstract: Overall, the incidence rates of breast cancer among women have continually increased since 1980 (American Cancer Society [ACS], 2005). Despite advances made in the prevention, diagnosis, and treatment of breast cancer over the past several decades, there continues to be a major disparity in breast cancer morbidity and mortality between African American and white women. ACS estimated that 211,240 U.S. women would be diagnosed with breast cancer in 2005 and 40,410 would die from the disease. African American women have a lower incidence of breast cancer than white American women (119.9 per 100,000 compared with 141.7 per 100,000), but a higher mortality rate (35.4 per 100,000 compared with 26.4 per 100,000) (ACS). There are a variety of reasons postulated to explain the lower incidence yet higher mortality rate of breast cancer in African American women, including less access to health care, lack of health insurance, lower socioeconomic status, communication barriers, and perceptions among this population that cancer is fatal (Paskett et al., 2004; Schwartz, Crossley-May, Vigneau, Brown, & Banerjee, 2003; Smedley, Stith, & Nelson, 2003). BREAST CANCER OUTREACH TO THE AFRICAN AMERICAN COMMUNITY: THE WITNESS PROJECT[R] The focus of outreach to combat mortality from breast cancer in African American women has been to develop culturally relevant and spiritually based programs aimed at dispelling many of the barriers to screening, diagnosis, and treatment held by African American women regarding cancer (Altpeter, Earp, Bishop, & Eng, 1999). Breast cancer is not a subject openly discussed among many in the African American community (Personal communication from K. Cuthbert, African American breast cancer survivor, U.S. Army, October 5, 2003) and many believe that treatment is not effective in saving lives (Phillips, 1999). Many African Americans view breast cancer as inevitably fatal and believe that there is little value in detecting the disease early. Long (1993) identified interventions noted "to be effective in empowering poor and African-American women to combat the fear and fatalism associated with a diagnosis of breast cancer" (p. 10) including community organization and coalition, health education and community outreach programs, client education to motivate desired behavior by framing the message in terms of gains or losses, among others. African American women use a combination of informal and formal supports to cope with their breast cancer (Henderson & Fogel, 2003). The Witness Project[R] (WP) was started in 1991 at the University of Arkansas Medical Science Center as a response to the high mortality rate of African American women with breast cancer living in Arkansas. This innovative project was designed to reach out to low-income and rural African American women in a way that was culturally relevant to increase awareness and participation in breast cancer screening (Erwin, Spatz, Stotts, Hollenberg, & Deloney, 1996). A community-based cancer screening program of proven effectiveness, the WP is grounded in the deep spiritual roots of African American women and uses affirmation to increase women's belief in their ability to seek action to save their lives. Breast cancer survivors, referred to as Witness Role Models, tell their breast cancer story--from detection through treatment--using the spiritual method of "witnessing," in which a person shares a personal religious experience with the congregation and testifies by explaining how this experience changed her life (Erwin, Spatz, & Turturro, 1992). Survivors are paired with a Lay Health Advisor who teaches breast self-exams (BSE) and talks about mammography and the role it plays in early detection. Erwin, Spatz, and colleagues (1996) suggested that the behavior of WP participants changes "because the messages are crafted to meet the women's beliefs ... [by] the witness role models present[ing] their stories within a framework that honors culture and local health beliefs" (p. …

Stress Constellations and Coping Styles of Older Adults with Age-Related Visual Impairment

Abstract: The ways in which individuals cope with difficult life challenges has captivated interest among social workers and health care providers. Several studies have provided empirical support for applying the stress and coping model to various chronic health conditions (Benn, 1997; Carver & Scheier, 1994; Folkman, Chesney, Pollack, & Coates, 1993; Lazarus & Folkman, 1984). Yet, existing literature on stress and coping has fallen short of confirming the underlying constructs of coping domains, requiring further research on domain-specific coping based on the nature of particular stressors (Brennan et al., 2001). The onset of chronic disability in later life involves a disruption in the equilibrium between person and environment, and it spurs a role transformation. Particularly, age-related vision loss has been identified as one of the most disabling conditions of later life, reducing an older person's ability to function independently at home and in the community (Branch, Horowitz, & Carr, 1989; Horowitz & Reinhardt, 2000; Morse & Rosenthal, 1996). Reduced vision can disrupt lifestyles in a broad range of behavioral, psychological, and social domains in terms of mobility, self-concept, and communication skills (Brennan & Silverstone, 2000). Hence, how one copes with vision impairment is an important factor in adaptation to this potentially disabling condition. A better understanding of patterns of stressors and coping styles would allow social work practitioners and researchers to better address the complex nature of and processes involved in this adjustment to visual impairment in late adulthood. STRESS AND FUNCTIONAL CHALLENGES ASSOCIATED WITH VISUAL IMPAIRMENT In 2002 among people age 40 and older in the United States, nearly one million were blind, and 2.4 million people had low vision, defined as best corrected acuity of 20/70 or poorer (Congdon, Friedman, & Lietman, 2003). In their recent examination of the prevalence of self-reported visual impairment among a nationally representative adult sample age 45 and older (N = 1,219), Horowitz and colleagues (2005) found that 16.6 percent of respondents self-reported visual impairments even when wearing glasses. This figure increased to 26.5 percent of those ages 75 and older. Risk factors of self-reported visual impairment were advanced age, poverty, poor self-rated health, and unavailability of informal social support. Numerous empirical and clinical studies have illustrated the functional challenges confronted by those who lived as sighted individuals and experienced visual impairment in later life. Reading is one of the most frequently cited challenges. Ryan and colleagues (2003) conducted in-depth semistructured interviews with 26 visually impaired seniors and illustrated the importance of reading for learning and life enjoyment both before and after vision loss. These respondents identified difficulty with such daily reading demands as small print, telephone dials, and medicine bottles--all of which have a negative effect on performance of instrumental activities of daily living (IADLs). Other large-scale nationally representative studies of older adults have found that visual impairment was strongly associated with difficulties in performing these and other IADL tasks (Brennan, Horowitz, & Su, 2005; Campbell, Crews, Moriarty, Zack, & Blackman, 1999). Mobility is also usually affected by visual impairment in late adulthood. There is a strong relationship between impaired vision and increased risk of accidents, particularly falls (Evans & Rowlands, 2004; Horowitz & Reinhardt, 2000). In a study of the community-travel habits and perceptions of a sample of 32 visually impaired elderly people and their sighted peers, Long and colleagues (1996) reported infrequent independent travel in the community among those with vision loss. In addition, the vast majority of these respondents with visual impairment (75 percent) were relatively dissatisfied with their ability to travel independently and with the number of opportunities they had to leave their homes in comparison with their sighted peers. …

Social work in the Department of Veterans Affairs: lessons learned.

Abstract: This article provides an overview of the practice of social work in the U.S. Department of Veterans Affairs (VA) and the role social workers have played in VA's transformation into a leading provider of health care. VA is the nation's largest employer of workers with MSW degrees, with more than 4,400 assigned to VA medical centers and clinics across the country. Social workers in VA provide the full range of psychosocial services, serve as mental health clinicians, and hold leadership roles within and outside social work. HISTORICAL PERSPECTIVE The VA has a long history of providing for the psychosocial needs of veterans. In 1926 a Veterans Bureau Order first established social services and resulted in the hiring of 36 social workers from the Civil Service register. These early hospital social workers functioned under the medical officer and assisted veteran inpatients with their social problems. Their duties included securing complete and trustworthy social histories on neuropsychiatric cases; assisting the neuropsychiatrist in affording satisfactory treatment by solving social problems which interfered with such treatment; investigating the home environment and cooperating with the Guardianship Officer in ascertaining and promoting the social adjustment of incompetent patients in their communities; and contacting, cooperating with, and securing the aid of social service agencies in the respective regional territories. (Black, 1926, pp. 1-4) Most of the patients had diagnoses of tuberculosis or psychiatric disorders. By 1930, when the Veterans Bureau was replaced with the Veterans Administration, there were 97 VA social workers and 18 junior social workers who qualified by training or experience as caseworkers assigned to 72 different duty stations across the country. These VA employees carried the designation of psychiatric or medical social worker and assisted veterans in receiving treatment and restorative services necessary to support their return to community living. Of the first 50 psychiatric social workers appointed, only 20 were college graduates with some social work training. Many had been recruited from the American Red Cross (Grant, 1932). After World War II and the influx of more than 16 million combat veterans, the focus of VA social workers shifted to providing social treatment for emotional and environmental factors that affected the health of veterans, their ability to use medical care, and their adjustment to illnesses and injuries. In 1946 there were 98 VA hospitals and 186 social workers. The preferred educational requirement was a BSW. By 1950, the complexity of the health care needs of veterans, including those suffering from "battle fatigue" resulted in the need for VA social workers to have more advanced training. The minimum educational requirement became an MSW from an accredited school of social work. By 1953 there were 1,352 social workers working in more than 200 VA hospitals (Kyle, 1980). EXPANSION IN NUMBERS AND ROLES As the number of social workers continued to grow in the 1960s, VA medical centers created social work departments (services) with social work chiefs to lead them (Kyle, 1980). To prepare social workers for these new leadership roles, the Social Work Administrative Leadership Training (SWALT) program was created in 1963. Over the next 34 years, 508 SWALT trainees graduated, with 362 going on to become a social work chief or assistant chief (Moses, 1996). In 1989 the Veterans Administration was converted to cabinet status, becoming the Department of Veterans Affairs and the largest of the 14 cabinets in the executive branch of the federal government. Numbering more than 3,000, VA social workers were assigned to all VA treatment programs and coordinated major medical center programs, such as the Community Residential Care Program, the Contract Community Nursing Home Program, the Spinal Cord Injury Program, and the Women Veterans Program (Burton, 2004). …

Psychosocial Evaluation Interview Protocol for Pretransplant Kidney Recipients

Abstract: Social work's potential role in preoperative evaluations was generally unheard of only 15 years ago, as it was considered the domain of direct health care professionals such as nurses and surgeons. Social workers have traditionally focused on the peri- and posttransplant phases. However, clinical social workers are playing an increasingly vital role in the care and psychosocial evaluation of potential kidney recipients and donors. Caring for and evaluating potential kidney recipients includes myriad unique clinical and personal challenges. This article's aim is to help clinicians gain a better clinical picture and assessment of people who choose to participate as kidney recipients by using a clinical interview protocol. Using this protocol with potential kidney recipients and their collaterals (family members, peer associates, clergy, and so forth) clarifies internal and external motivations and issues. Furthermore, using such a protocol can help clinicians ascertain potential barriers and obstacles that could interfere with a patient's compliance and can perhaps help clinicians deal with such obstacles in a more comprehensive manner. Finally, this article also attempts to illuminate the ethical complexities involved in choosing to be a potential kidney recipient.

Addressing Sexual Issues in Individuals with Chronic Health Conditions

Abstract: Although literature that addresses the treatment of sexuality for the majority population has been written within the field of social work and other disciplines, little attention has been paid to the sexuality issues of individuals with chronic health conditions in mainstream social work journals. A literature search of Social Work Abstracts from 1977 to 2004 revealed only 44 articles addressing sexual dysfunction. One publication, The Journal of Social Work and Human Sexuality, was dedicated to the area of sexuality from 1982 to 1993, when it discontinued publication. During its 10-year publication history, only two issues were devoted to the sexuality issues of individuals with chronic health conditions. The purpose of this article is to provide social workers with information about the PLISSIT model (Annon, 1974), the "state-of-the art" intervention used for the treatment of sexuality issues (McCarthy, 2001; Borelli-Kerner & Bernell, 1997), and one that we have used in our professional social work practice with individuals who have chronic health conditions. A DEFINITION OF CHRONIC HEALTH CONDITIONS Chronic medical conditions are defined using Rolland's (1994) psychosocial typology of illness, which includes the following four characteristics: (1) the onset of illness is acute or gradual; (2) the illness is progressive, chronic, or relapsing; (3) the illness may be nonfatal, shorten life span, or cause sudden death; and (4) the levels of incapacitation can vary. Defining chronic health conditions using these four broad patterns allows for the inclusion of traumatic onset disabilities, such as spinal cord injury, and disabilities associated with certain chronic conditions, such as diabetes, as well as chronic conditions that are life threatening, stable, or progressive, such as cancer, low back pain, or multiple sclerosis. SOCIAL WORK INTERVENTION: PLISSIT MODEL Despite a lack of empirical evidence, the PLISSIT model has been consistently identified in the literature as helping people with disabilities or chronic illnesses who have sexuality issues, even though the model was not developed specifically for this population (Sipski & Alexander, 1997; Westgren & Levi, 1999). However, there has not been an explicit rendition of using the PLISSIT model with this population in social work journals. PLISSIT stands for the four levels of intervention: (1) Permission Giving, (2) Limited Information, (3) Specific Suggestions, and (4) Intensive Therapy. Each level of treatment builds on the previous one, and a therapist can move back and forth between the levels of treatment. As treatment moves from level to level, the degree of skill required of the clinician increases as does the intensity of work with the client. The PLISSIT model is applicable to individuals with heterosexual and homosexual orientations because the interventions are specific to the client, the chronic health condition, and the sexual concern of the client and the client's partner. Level 1: Permission Giving The social worker gives the client permission to talk about sexuality through the use of statements that normalize the discussion and invite the client to ask questions. During the usual assessment process, the social worker may probe, "We have discussed a number of areas in which your condition has disrupted your life. Many people find that their sexual life has also changed. Have you experienced any changes in your sex life that you would like to discuss?" When a client initiates a discussion, the clinician responds with a permission-giving statement that assures the client that these issues are important and gives the client general information always to adapt his or her sex life to the chronic condition. Level 2: Limited Information A greater degree of comfort is necessary on the part of the social worker at level 2 because the client is given information directly related to the sexual concern identified. …

A Practitioner's Response to the New Health Privacy Regulations

Abstract: The established professional practice requiring informed consent for the disclosure of personal health information with its implied right to privacy suffered a serious setback with the first federal privacy initiative of the Bush administration. The new Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L. 104-191) privacy regulations supplant the patient's veto regarding disclosure with the requirement that the patient simply receive a written notice of the provider's policy on disclosure of personal health information. As the privacy paradigm shifts to balance the business interests of the health care industry with those of individual patients, this policy presents new challenges for protecting the confidential relationship between the practitioner and the patient. This article reviews the significant modifications in the new HIPAA regulations, briefly critiques these changes, and suggests strategies for practitioners to manage these changes.

Improving Psychosocial Care in Nursing Home Settings: The Next Challenge

Abstract: Imagine the nursing home setting in the United States as a place in which stronger research and practice connections are tested in a social laboratory-type setting, where strategies to improve the psychosocial well-being of nursing home residents are implemented, and social work's contributions to resident quality of life and quality of care are better articulated and actualized. The creation of this type of setting has the potential to encourage the highest quality of social work practice. The research implemented in these types of settings has the promise to better inform health care policy debate, improve the quality of care for nursing home residents, and support the development of more effective and efficient monitoring and quality improvement strategies in our nation's 17,000 nursing facilities. Quality nursing home care is an issue for public concern as about 5 percent of elderly people live in these facilities, including a higher percentage of the oldest old (85 years and older), as well as an increasing number of patients who cycle through nursing facilities, which are increasingly providing subacute care. Decent and responsive nursing home care is an emerged issue for the 21st century. Multifaceted strategies are required to improve resident outcomes, enhance the quality of nursing home care, persuade more social workers to seek nursing home jobs, and encourage more social work researchers to examine psychosocial care in nursing facilities. These strategies should include the development and testing of effective psychosocial interventions for our burgeoning aging population. The first facet to examine is the weak federal requirement for social services in nursing homes. Federal regulations regarding "Quality of Life" in nursing homes and other long-term care facilities (42 C.ER. 483.15) specify that all facilities must provide "medically-related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident." Nursing home reform legislation passed in 1987 had sought to meet these needs by requiring that all nursing facilities provide social services and that those with more than 120 beds have at least one full-time social worker with at least a bachelor's degree in social work or another human service field and one year of supervised social work experience in a health care setting working directly with individuals. Since the passage of the 1987 Nursing Home Reform Act (as part of the Omnibus Budget Reconciliation Act, P.L. 100-203), however, social work and nursing home advocates have worked to strengthen the staffing standards without success. Continuing concerns led social work groups, including the Institute for the Advancement of Social Work Research (IASWR), the National Association of Social Workers (NASW), and nursing home advocates to request that the Inspector General of the Department of Health and Human Services examine psychosocial care in nursing homes. In 2003 the Office of the Inspector General (OIG) released a report,"Psychosocial Services in Skilled Nursing Facilities," documenting gaps in the delivery of psychosocial care in Medicare-supported nursing facilities. The findings indicated that all residents had at least one psychosocial need, but 39 percent of residents' charts had inadequate psychosocial care plans and 46 percent with care plans did not receive all of the planned services (OIG, 2003). The OIG report also highlighted the absence of a comprehensive approach to monitoring and measuring psychosocial care and quality of life. Furthermore, the report noted that many social workers interviewed indicated that they encounter barriers in trying to meet those needs. The OIG report served as a catalyst for further exploration and the development of an action plan that would support service delivery improvements and more focused research and evaluation efforts. There was a need to better describe what "best practice" social work services in nursing homes look like and what mechanisms exist to better monitor psychosocial care. …

Social Work Ethics Audits in Health Care Settings: A Case Study

Abstract: In recent years social workers in health care settings have paid increased attention to ethical issues and decision making. Along with members of allied health professions, social workers have enhanced their understanding of ethical challenges related to organ transplantation, the use of artificial organs, end-of-life decisions, genetic engineering, aggressive treatment of seriously impaired infants and frail elders, abortion, managed care, and the protection of participants in research protocols (Congress, 1998; Foster, 1995; Loewenberg & Dolgoff, 1996; Reamer, 1985, 2006). Most recently, various health care professions have begun to recognize the relevance of ethics "risk management" (Cohen-Almagor, 2000; Reamer, 2001a). Risk management is a concept that emerged in the 1960s; originally, the concept referred to efforts to minimize business-related losses resulting from accidents, theft, and negligence (Vaughan & Vaughan, 2000). Over time, risk management has broadened in scope to include many other settings and contexts, including various health professions. A broad range of health agencies now pay considerable attention to steps they can take to minimize the likelihood of harm to clients and staff, prevent ethics complaints (filed with professional associations and state licensing and regulatory boards), and prevent lawsuits alleging some form of ethics-related negligence (for example, conflicts of interest, inappropriate dual relationships or boundary violations, unethical delivery of services, mishandling of confidential information, and unethical termination of services (Barker & Branson, 2000; Houston-Vega & Nuehring, 1997; Reamer, 1998, 2003; Strom-Gottfried, 1999). This article describes a practical strategy--the Social Work Ethics Audit--that promotes ethical practice in health settings and minimizes ethics-related risks. THE SOCIAL WORK ETHICS AUDIT The Social Work Ethics Audit (SWEA) (Reamer, 2001b) provides social workers and their agencies with an easy-to-use tool to examine their ethics-related practices, policies, and procedures; ensure quality; and promote ethics-related risk management. SWEA provides social workers with a tool to help them identify pertinent ethical issues in their practice settings, review and assess the adequacy of their current practices, design a practical strategy to modify current practices as needed, and monitor the implementation of this quality assurance strategy. The audit is especially useful to administrators whose agencies seek accreditation and to supervisors who want to structure their ethics-related discussions with supervisees. SWEA includes a structured instrument and protocol that facilitate this comprehensive assessment. The audit focuses on specific ethical risks found in human services settings: client rights, confidentiality and privacy, informed consent, high-risk interventions, boundary issues, conflicts of interest, documentation, defamation of character, client records, supervision, staff development and training, consultation and referral, fraud, termination of services, practitioner impairment, and evaluation and research. The ethics audit involves six key steps: (1) form an audit committee; (2) using the topical outline, identify specific ethics-related issues on which to focus; (3) gather forms, policies, regulations, and other documents required for the audit; (4) assess multiple topics in 16 discrete risk areas and assign a score on a four-point scale indicating no risk, minimal risk, moderate risk, or high risk; (5) develop a comprehensive, detailed "action plan" for each risk area that warrants attention, starting with high-risk areas; and (6) establish a mechanism to follow up on each task to ensure its completion and monitor its implementation. (SWEA is accompanied by a computer disk that facilitates the audit process.) The assessment of each risk area is divided into two sections: policies and procedures. …