Showing papers in "Health & Social Work in 2013"

Unequal Burden of Disease, Unequal Participation in Clinical Trials: Solutions from African American and Latino Community Members

Abstract: Exciting new medical therapies for a number of diseases that disproportionately affect African Americans and Latinos are currently being developed and tested in clinical trials (Robinson & Trochim, 2007). Despite bearing an unequal burden of disease, African Americans and Latinos continue to be underrepresented in clinical trials research, even though the National Institutes of Health Revitalization Act of 1993 (P.L. 103-43) stipulating the participation of women and minority groups in research was created in 1993 and updated in 2001 (Pinsky et al., 2008). Insufficient representation of racially and ethnically diverse groups and women in clinical trials results in inequitable distribution of the risks and benefits of research participation and reduces the generalizability of trial results (Pinsky et al., 2008). Health disparities in the United States could be reduced if targeted therapies were discovered that work equally well in all populations or work especially well in members of affected racial and ethnic groups. The purpose of this study was to use qualitative data obtained via focus groups with African American and Latino adults ages 50 years and older to elicit potential solutions to the problem of low rates of participation of such populations in clinical trials research. The conceptual framework of the study was based on the Institute of Medicine (IOM) report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare (Smedley & Nelson, 2003), which identified three factors as major sources of racial and ethnic disparities in health outcomes: (1) characteristics of health care systems, (2) perceptions of and actual interactions with health care providers, and (3) preferences and attitudes of patients. We applied IOM's conceptual framework to the arena of disparities in recruitment of diverse populations to clinical trials research by revising the wording of the IOM framework to refer to clinical trials research instead of to health care disparities. For example, in the framework, we replaced “health care systems” with “health care systems and study processes,” “health care providers” with “researchers,” and “patients” with “potential trial participants.” The revised framework is depicted in Figure ​Figure11 and is described in the following sections. The conceptual framework is related to the systems approach in the field of social work, in which clients and their needs are related to a multilevel model of resources, systems, and institutions (Darnell, 2007; NASW, 2008). Figure 1: Model Framework of Multilevel Factors Affecting Decision to Participate in a Clinical Trial

Mental Health and Poverty in the Inner City

Abstract: Rapid urbanization globally threatens to increase the risk to mental health and requires a rethinking of the relationship between urban poverty and mental health. The aim of this article is to reveal the cyclic nature of this relationship: Concentrated urban poverty cultivates mental illness, while the resulting mental illness reinforces poverty. The authors used theories about social disorganization and crime to explore the mechanisms through which the urban environment can contribute to mental health problems. They present some data on crime, substance abuse, and social control to support their claim that mental illness reinforces poverty. The authors argue that, to interrupt this cycle and improve outcomes, social workers and policymakers must work together to implement a comprehensive mental health care system that emphasizes prevention, reaches young people, crosses traditional health care provision boundaries, and involves the entire community to break this cycle and improve the outcomes of those living in urban poverty.

Social Work and Implementation of the Affordable Care Act

Abstract: The Affordable Care Act (ACA) (full title: The Patient Protection and Affordable Care Act) (P.L. 111-148) will generate sweeping changes in the financing, organization, and accessibility of health and social services in the United States. The expansion of Medicaid and the establishment of state health insurance exchanges (HIEs) will vastly expand insurance access in the United States, with an estimated 30 million Americans gaining coverage (Banthin et al., 2012). The emphasis on integrated models of care, including patient-centered medical homes and accountable care organizations, introduces new opportunities to improve care coordination, reduce unnecessary service use, and make health care more cost-effective. Realizing these changes relies on the work of many health care professions. In this editorial, we make a case for how the social work profession can forge a leadership role in implementing this historic legislation. SOCIAL WORK EXPERTISE AND THE ACA Because the ACA is so bold and ambitious, it is important to consider how the unique skills and knowledge bases of social work and other health care professions align with its objectives and goals. An integrated approach is needed to maximize the ACA's potential to improve the health of the population. Four central qualities of the social work profession make it uniquely suited to advance a number of the objectives and goals of the ACA. First, social work situates individuals in the social contexts in which they live. Social workers understand that individuals are part of social networks, neighborhoods, and communities that influence their health choices and participation in health care. Understanding these social relationships provides us with insight into health behaviors and health outcomes that is necessary to achieve population health goals. Social workers likewise understand the relationship between health, education, employment, and other systems that form the nexus from which resources can be drawn to protect, maintain, and restore health. Social workers are familiar with the complex and overlapping systems that must be negotiated to ensure that the social, psychological, and economic needs of individuals and groups are addressed in a way that underscores optimal health. For instance, social workers know how to ensure that patients have what they need from multiple systems upon discharge, that discharge instructions are understood, and that resources are in place to ensure that those instructions can be followed. This knowledge is essential for avoiding unnecessary readmissions--events subject to financial penalties under the ACA. In a related sense, social work is guided by an evidence base that is informed by rigorous research within communities and collective wisdom gleaned from over a century of social work practice. Of importance is social workers' research to understand how mental health and physical health interact to enhance or impede functioning and patients' participation in health care treatment. Social workers devise plans based on knowledge of how the two interact and can help to ensure that the communication occurs that underlies optimal, sustained functioning and wellness. Evidence-based social work practice begins where individuals and groups are, in a way that is sensitive to cultural beliefs and health literacy. This orientation helps to ensure that recommendations for disease prevention and care management are understood and that patients and families are able to follow instructions when individuals become ill. It is important to consider one additional quality of social work, not because it is directed at those who will be covered by the ACA, but because it considers those who will not be covered. Approximately 29 million Americans will still lack health insurance after the ACA is fully instituted (Banthin et al., 2012). Social workers historically have targeted their services to such disenfranchised groups, including those who do not have a stable place in society, may lack housing and other basic services, and have no or irregular contact with the health system. …

Bouncers, Brokers, and Glue: The Self-described Roles of Social Workers in Urban Hospitals

Abstract: Social workers delivering services in health care settings face unique challenges and opportunities. The purpose of this study was to solicit input from social workers employed in urban hospitals about their perceptions of the roles, contribution, and professional functioning of social work in a rapidly changing health care environment. Using qualitative methods, the university and hospital-based research team conducted seven focus groups (n = 65) at urban hospitals and analyzed the data using an interpretive framework with ATLAS.ti software. Seven major themes emerged from the participants' description of their roles: bouncer, janitor, glue, broker, firefighter, juggler, and challenger. Along with descriptions of the ways social workers fulfilled those roles, participants articulated differences in status within those roles, the increasing complexity of discharge planning, and expectations to provide secondary support to other health care professionals on their teams. Implications for practice and research are discussed.

An Examination of the Psychometric Properties of the Vicarious Trauma Scale in a Sample of Licensed Social Workers

Abstract: Vicarious trauma (VT) involves affective distress and shifts in cognitive schemas following secondary exposure to traumatic material. The Vicarious Trauma Scale (VTS) is a brief measure designed to assess distress resulting from such exposure and has potential as a screening tool for VT in practice and educational settings. The current study is the first examination of the psychometric properties of the VTS in a sample of social workers (n = 157) collected in a cross-sectional survey. Results from item response models (IRM) and confirmatory factor analysis (CFA) suggest the VTS has good to excellent psychometric properties and could be a general screening tool for exposure to traumatic material or distressed clients and a measure of the affective and cognitive impact of such exposure. Both CFA and IRM approaches suggest a two-dimensional solution for the VTS, corresponding to cognitive and affective components. Implications for research and applications to practice are discussed.

Examining Cultural Competence in Health Care: Implications for Social Workers

Abstract: This article examines and unpacks the "black box" of cultural competence in health interventions with racial and ethnic minority populations. The analysis builds on several recent reviews of evidence-based efforts to reduce health disparities, with a focus on how cultural competence is defined and operationalized. It finds that the use of multiple similar and indistinct terms related to cultural competence, as well as the lack of a mutually agreeable definition for cultural competence itself, has resulted in an imprecise concept that is often invoked but rarely defined and only marginally empirically validated as an effective health intervention. This article affirms the centrality of cultural competence as an essential values-based component of optimal social work practice, while also suggesting future directions for operationalizing, measuring, and testing cultural competence to build an evidence base on whether and how it works to reduce health disparities.

Effect of Service Barriers on Health Status of Aging South Asian Immigrants in Calgary, Canada

Abstract: This study examined the relationships between service barriers and health status of aging South Asian immigrants. Data were obtained through a structured telephone survey with a random sample of 220 South Asians 55 years of age and older. The effect of the different types of service barriers on the physical and mental health of participants was examined using hierarchical multiple regression, while adjusting for participants' sociocultural demographic backgrounds. An average of 5.9 types of service barriers were reported. Among the four major types of barriers--cultural incompatibility, personal attitude, administrative problems, and circumstantial challenges--more barriers related to personal attitude predicted less favorable physical and mental health. In regard to health prevention, culturally appropriate strategies should be developed and implemented to help aging South Asians to overcome barriers related to personal attitude so that they can have better access to appropriate services.

Validation of the Chinese Version of the Modified Caregivers Strain Index among Hong Kong Caregivers: An Initiative of Medical Social Workers

Abstract: Family caregivers may often experience caregiving stress and burden. To systematically assess this issue, medical social workers may need to use a brief and valid measurement in their practice. In the Hong Kong Chinese context, one additional challenge is to examine whether a measurement developed in the West is valid for Hong Kong Chinese caregivers. Thus, medical social workers in Hong Kong initiated this research study to validate the Chinese version of the Modified Caregiver Strain Index (C-M-CSI). A total of 223 Chinese caregivers of patients with various chronic illnesses were recruited for this validation study. C-M-CSI demonstrated good reliability (Cronbach's alpha coefficient = .91), concurrent validity with the Chinese version of the Caregiver Burden Inventory, and discriminant validity with the Chinese version of the Meaning in Life Questionnaire. Factor analysis yielded a single factor as the original M-CSI, which explained 49 percent of variance. Construct validity was shown by differentiating spousal and nonspousal caregivers, as well as caregivers of patients with and without behavioral problems. C-M-CSI is recommended as a brief and valid measurement that can be used by medical social workers in assessing the caregiving strain of Chinese caregivers of patients in Hong Kong.

Factors Leading African Americans and Black Caribbeans to Use Social Work Services for Treating Mental and Substance Use Disorders

Abstract: This secondary analysis of 5,000 African Americans and black Caribbeans explored how their use of social work services to address mental and substance use disorders was associated with the disorder involved as well as their perceived need for services, belief system, family resources, proximity to services, social-structural factors, and demographic characteristics. The sample was extracted from a national data set. Results of multinomial logistic regression showed that use of social work services was increased by dual diagnosis, substance use disorder alone, and mental disorder alone; by deteriorating mental health; by perceived stigma in treatment use; by welfare receipt and insurance coverage for mental health services; and by college graduation. Results also showed that use of services outside social work was promoted by dual diagnosis, substance use disorder alone, and mental disorder alone; by deteriorating mental health; by experience of racial discrimination; by insurance coverage for mental health services; by college education or graduation; and by female gender and increasing age. The findings' implications for social work intervention and education are discussed.

Part of the Job? Workplace Violence in Massachusetts Social Service Agencies

Abstract: Workplace violence is a serious and surprisingly understudied occupational hazard in social service settings. The authors of this study conducted an anonymous, Internet-based survey of Massachusetts social service agencies to estimate the incidence of physical assault and verbal threat of violence in social service agencies, understand how social service agencies collect data on workplace violence, and identify disparities in who is at risk in terms of staff education and training level and the work setting. The study gathered general descriptions of each agency and compiled incidence data on workplace violence that were collected by agencies in fiscal year 2009. The key findings of this descriptive study showed high rates of workplace violence against social services providers and a pattern of risk disparity, with significantly more risk for direct care versus clinical staff. These results are based on data routinely collected by social service agencies that typically remain unexamined. A research agenda that is sensitive to potential occupational health disparities and focuses on maximizing workplace safety in social services is needed. Language: en

The Caregiver Well-Being Scale: Developing a Short-Form Rapid Assessment Instrument

Abstract: The Caregiver Well-Being Scale (CWBS) is a 43-item instrument that was designed in the 1990s to help family caregivers, clinicians, and researchers identify areas ofcaregiver strength and areas in which additional support is needed. This article describes the development of a 16-item version of the CWBS and discusses the methods used in testing the psychometric properties of the shortened version in a sample of 493 family caregivers. It concludes that the shortened version is valid, reliable, and easier to use than the original version but has the same goals and continues to be applicable in research and clinical settings.

Racial Disparities in the Use of Physical Restraints in U.S. Nursing Homes

Abstract: The use of physical restraints in nursing homes among black and white residents was examined on the basis of data from the 2004 National Nursing Home Survey to determine if black residents were more susceptible to the use of physical restraints. Odds ratios acquired through logistic regression are provided with 95 percent confidence intervals. Findings revealed that black residents are more likely than white residents to be restrained with bed rails, side rails, and trunk restraints. Findings suggest that racial disparities exist in the use of physical restraints. Implications for practice, policy, and research are discussed.

Navigators and Assisters: Two Case Management Roles for Social Workers in the Affordable Care Act

Abstract: Social workers can help ensure successful implementation of the Patient Protection and Affordable Care Act (PPACA, hereafter ACA) (P.L. 111-148). This became clear to me as I attempted to find my way through the 2,400-page-long ACA, looking for the "low-hanging fruit": places where there was evidence that social work would be effective and there was a natural fit because of social workers' specialized training and professional code of ethics. There are, in fact, many such places in the ACA, particularly where one encounters the terms "case management," "care coordination," and "care management"--terms that occur 39 times. With each such mention is an opportunity for social work to meet the ACA's goal of reducing costs by improving health through a set of activities that the social work profession calls "social work case management." The National Association of Social Workers (1992) defines social work case management as "assess[ing] the needs of the client ... and arrang[ing], coordinat[ing], monitor[ing], evaluat[ing], and advocat[ing] for services" to address the client's needs; Two characteristics set social work case management apart from other kinds of case management. First, social work has a dual focus on the person and the environment. Social work's biopsychosocial focus means that social workers are concerned with the interaction between the body, the mind, and the social system. Second, social workers carry out case management by using a strengths-based approach, which focuses on strengths rather than deficits and views the community as an "oasis of resources" (Etzel-Wise & Howley, 2006). Because of its potential to improve health outcomes and reduce costs, case management has entered a renaissance period. Indeed, we have witnessed a proliferation of various kinds of case management programs in recent years, most notably patient navigator programs (Dohan & Schrag, 2005; Freeman, Muth, & Kerner, 1995; Freund, 2011; Vargas, Ryan, Jackson, Rodriguez, & Freeman, 2008; Wells et al., 2008). The ACA invigorates this trend. In this Viewpoint, I focus on how social workers can positively impact implementation of the ACA by doing what they do well--social work case management--through two new roles envisioned by the ACA: navigators and assisters. These roles are important because they can affect the three major milestones of the ACA: people obtaining coverage for the first time through Medicaid or the exchanges; people making efficient use of their insurance benefits; and, finally, bending the cost curve, a product of achieving the first two milestones. NAVIGATORS The success of the ACA will be measured initially on the basis of its performance on the first milestone: enrolling currently uninsured people in eligible health insurance programs. Previous research suggests that this is not an easy task. A recent report from the Office of the Assistant Secretary for Planning and Evaluation summarizes the evidence of "take-up rates" in Medicaid among adults (Sommers et al., 2012). The take-up rate refers to the percentage of eligible people who actually end up enrolled. Overall, studies show that take-up rotes range from 32 percent to 81 percent, but if one excludes tile studies that are known to produce upwardly biased estimates, the take-up rotes are much mole modest: between 32 percent and 52 percent. These take-up estimates are often much lower than the published take-up projections for the ACA. The take-away message from the take-up literature is that states will face a formidable challenge in enrolling eligible populations. A recent report by the Kaiser Commission on Medicaid and the Uninsured about the experiences of uninsured adults who could gain Medicaid coverage underscores the enrollment challenge before us (Perry, Mulligan, Artiga, & Stephens, 2012). In focus groups conducted across the country, participants were largely unaware of the new law. …

Intimate Partner Violence Exposure in Early Childhood: An Ecobiodevelopmental Perspective

Abstract: Approximately 15.5 million children in the United States reside in households in which interpersonal violence is recurrent. Young children are more likely than older children to be present in the home when violence between adults occurs. In a recent technical report, the American Academy of Pediatrics renewed its call to invest in research and intervention resources for children younger than five years of age. The report also outlined the ecobiodevelopmental (EBD) framework, an emerging cross-disciplinary understanding of stress and coping response in very young children. The EBD framework explains how unresolved stress experienced by infants, toddlers, and preschoolers has toxic effects on their development. The framework could also expand opportunities for social workers who have an interest in research and clinical work involving very young children exposed to violence.

Incorporating Discussion of Sibling Violence in the Curriculum of Parent Intervention Programs for Child Abuse and Neglect

Abstract: Physical and emotional violence among siblings is one aspect of family dynamics that is often overlooked by practitioners working with children and families receiving services for abuse and neglect. One reason for this may be the limited attention that violence between siblings has received in comparison with other forms of family violence. Button and Gealt (2010) noted the need for more research in this area as well as increased efforts to prevent this form of family violence. One national study identified sibling violence as the most common form of family violence (Straus, Gelles, & Steinmetz, 1980); others have concluded that sibling conflict is rather typical, stating that it occurs daily for approximately 50 percent of young children (Dunn & Kendrick, 1982). The effects of sibling violence can lead to poor peer relations and behavioral problems (Stormshak, Bellanti, & Bierman, 1996); depression and anxiety (Duncan, 1999); and continued self-blame, depression, substance abuse, eating disorders, interpersonal relationship problems, and posttraumatic stress disorder (PTSD) (Wiehe, 1997). Sibling violence has also been associated with the occurrence of peer bullying (Ensor, Marks, Jacobs, & Hughes, 2010; Finkelhor, Tumer, & Ormrod, 2006), suggesting that this form of family violence may have indirect implications for the health of others outside the family. However, these findings seem to have had limited inclusion in intervention programs serving children and families. This article seeks to draw attention to this often overlooked family dynamic and to recommend ways to integrate this content into parenting intervention programs. Following a brief overview of some of the factors often associated with psychological and physical abuse, findings from interviews with five practitioners who conduct parenting intervention groups are summarized. Recommendations are provided for how practitioners could bring greater attention to sibling violence in their parent intervention programs. OVERVIEW OF THE PROBLEM Mental health has been described as "indispensable to personal well-being, family and interpersonal relationships, and contribution to community or society" (U.S. Department of Health and Human Services, 1999, p. 4). Physical abuse is associated with such psychiatric disorders as PTSD, conduct disorder, attention-deficit/hyperactivity disorder (Famularo, Kinscherff, & Fenton, 1992), depression (Kolko, 2002), aggression and anxiety (Azar & Wolfe, 1998), and impaired social functioning with peers (Salzinger, Feldman, Hammer, & Rosario, 1993). Psychological maltreatment, which includes verbal abuse and threats, is associated with depression, conduct disorder, and delinquency (Kazdin, Moser, Colbus, & Bell, 1985) and can impair social and cognitive functioning in children (Smetana & Kelly, 1989). Research has also linked parental verbal aggression and children's psychosocial problems (Moore & Pepler, 2006), even when no physical abuse is present. Children who are abused often lack resources to manage their own frustration, stress, and anger. This lack of self-control may result in their venting their anger on others. Longer term effects include the potential for children who have been abused to repeat the abuse and neglect in the future with their own children. Child neglect has been associated with academic problems, aggression, and low self-esteem (Erickson & Egeland, 2002) as well as anxious and inattentive behaviors at school (Corcoran, 2000). The fact that child well-being improves when parental maltreatment is reduced speaks to both the importance of resilience and the need for family intervention (Christoffersen & DePanfillis, 2009). Parent intervention programs are one way to decrease or eliminate child maltreatment and enhance parenting skills to improve family health and functioning. Parenting Intervention Programs Parent education is commonly used in child welfare (Barth et al. …

Better Colon Cancer Care for Extremely Poor Canadian Women Compared with American Women

Abstract: Extremely poor Canadian women were recently observed to be largely advantaged on most aspects of breast cancer care as compared with similarly poor, but much less adequately insured, women in the United States. This historical study systematically replicated the protective effects of single- versus multipayer health care by comparing colon cancer care among cohorts of extremely poor women in California and Ontario between 1996 and 2011. The Canadian women were again observed to have been largely advantaged. They were more likely to have received indicated surgery and chemotherapy, and their wait times for care were significantly shorter. Consequently, the Canadian women were much more likely to experience longer survival times. Regression analyses indicated that health insurance nearly completely explained the Canadian advantages. Implications for contemporary and future reforms of U.S. health care are discussed.

Tobacco Training in Clinical Social Work Graduate Programs

Abstract: The leading cause of preventable death, in the most vulnerable segments of society, whom social workers often counsel, is cigarette smoking. The purpose of this study was to assess tobacco smoking cessation training in clinical social work programs. A valid 21-item questionnaire was sent to the entire population of 189 clinical graduate social work programs identified by the Council on Social Work Education. A three-wave mailing process was used to maximize the return rate. Directors from 112 clinical social work programs returned completed questionnaires (61 percent). The majority (91 percent) of directors reported having never thought about offering formal smoking cessation training, and only nine of the programs (8 percent) currently provided formal smoking cessation education. The three leading barriers to offering smoking cessation education were as follows: not a priority (60 percent), not enough time (55 percent), and not required by the accrediting body (41 percent). These findings indicate that clinical social work students are not receiving standardized smoking cessation education to assist in improving the well-being of their clients. The national accrediting body for graduate clinical social work programs should consider implementing guidelines for smoking cessation training in the curriculums.

Use of Psychosocial Services Increases after a Social Worker–Mediated Intervention in Gynecology Oncology Patients

Abstract: The purpose of this study was to determine whether the introduction of psychosocial services to gynecologic oncology outpatients by a social worker increases service use. During the initial six weeks (phase I), patients were referred for psychosocial services by clinic staff. During the second six weeks (phase II), a nurse introduced available services to each patient with a brochure. During the final 12 weeks (phase III), a social worker introduced services to each patient. The authors then compared psychosocial service referral rates. The sample included 196 patients. During phase III, the probability of a patient-initiated referral increased 3.4-fold (95 percent confidence interval [CI] [1.1, 10.4], p = .04) compared with baseline; the probability of any referral rose 2.7-fold (95 percent CI [1.1, 6.3], p = .03). The mean time to referral decreased from 79.4 days at baseline to 3.9 days during phase III (p < .001). The phase III intervention was accomplished only in 34 patients (39 percent) because of scheduling conflicts. Of these, eight requested referral, resulting in a 24 percent patient-initiated referral rate after meeting with a social worker. The introduction of psychosocial services by a social worker to gynecologic oncology outpatients increases referral rates and expedites evaluation.

Department of Health and Human Services Changes: Implications for Hospital Social Workers

Abstract: In April 2010, President Obama issued a directive to the Secretary of Health and Human Services (HHS) regarding patient visitation, advance directives, and other initiatives to improve the lives of lesbian, gay, bisexual, and transgender people and their families. The HHS response to this directive has implications for hospital social workers. The purpose of this secondary data analysis was to explore indicators of social work readiness to support implementation of the resulting initiatives. A historical context for the changes is provided, inclusive of the cases that spurred the presidential memorandum. The findings are presented within the framework of the profession's standards for social work practice in health care and end-of-life care. Recommendations for enhancing social work readiness for a critical role in implementation of the new regulations are presented.

Online Training on Fetal Alcohol Spectrum Disorders for Court-Appointed Special Advocates Volunteers

Abstract: Fetal alcohol spectrum disorders (FASDs) are a leading cause of developmental disabilities. Children within the child welfare system are five to 10 times more likely than other children to experience these symptoms. Court Appointed Special Advocates (CASA) volunteers are uniquely positioned to identify these children and refer them for assessment and services. This study used a one-group pretest-posttest design to assess the impact of a three-hour online FASDs training on CASA workers' knowledge of FASDs and their comfort and confidence in identifying children with FASDs for referral, advocating for them, and linking them to services. The training and assessment measures were completed by 338 CASA volunteers and staff from 55 CASA locations in Texas. Wilcoxon matched-pairs tests and paired t tests were used to assess change in each of the dependent measures. All comfort and confidence items showed significant improvement from pretest to posttest; there was also a significant improvement in knowledge. These results support the potential of this online training to enhance CASA volunteers' ability to help children with FASDs.

Mind–Body Techniques, Race–Ethnicity, and Depression among Urban Senior Center Participants

Abstract: As the older adult population grows and becomes more diverse, more of its members are turning to complementary and alternative medicine (CAM). There are mixed findings regarding racial and ethnic differences in the use of CAM. This article explores racial and ethnic differences in use of a category of CAM known as mind-body techniques (MBT) among senior center participants with symptoms of depression. It also examines the relationship between use of MBT and depression severity. A cross-sectional survey was conducted with a representative sample of senior center participants in New York City, from which a subsample of those with depressive symptoms was drawn. Racial and ethnic differences in MBT use were identified, as was a significant negative relationship between MBT use and depression severity. African American elders were more likely to have used MBT than other racial or ethnic groups. When controlling for race or ethnicity, health status, and barriers to medical care, predictors of depression severity included health status, experiencing barriers to medical care, and Hispanic identity. Findings suggest that being female or younger is associated with a higher likelihood of using CAM. Contrary to some prior research, education level was not associated with use of MBT.

Detection of Memory Impairment in a Community-Based System: A Collaborative Study

Abstract: Populations throughout the world are both increasing and aging. However, aging is not just a modern problem. Over the last two centuries, the number of older adults has been increasing. The rapid growth in the number of older people has resulted not only in an increased requirement for services (health, social, and psychological), but also in the possibility of increased prevalence of disorders such as dementia. The term dementia refers to a syndrome that includes the deterioration of at least two cognitive functions, including memory, language, visuospatial perception, and executive function. At first, dementia usually presents as a form of forgetfulness. However, as the disease progresses, both a global cognitive decline and neuropsychiatric symptomatology begin to appear alongside memory impairment. Caring for a patient with cognitive and neuropsychiatric impairments is stressful, and the caregivers of dementia patients are subsequently laden with a heavy psychological burden (Levesque, Ducharme, & Lachance, 1999). Both Waite, Bebbington, Skelton-Robinson, and Orrell (2004) and Roth, Mittelman, Clay, Madan, and Haley (2005) suggested that caregivers experience a decrease in life satisfaction and an increase in depression. This means that dementia is not only a neurological disease, but also a community health problem. For the majority of patients, the onset of dementia is gradual. In the early stages, memory complaints are common among patients. These complaints can be signs of mild cognitive impairment (MCI). MCI is defined as memory impairment without an accompanying impairment in social function (Feldman & Jacova, 2005). The cognitive impairment levels of patients with MCI are not at a sufficient level for dementia to be diagnosed (Petersen et al., 1999). However, although MCI is not sufficient for diagnosis, it is a risk factor for Alzheimer's disease (AD) and other types of dementia. In addition, AD is responsible for half of all cases of dementia. There have been several attempts to explain the rates and risk factors for the conversion of MCI to AD. The risk of developing AD among patients with MCI ranges from 10 percent to 15 percent per year. This increases by over 40 percent after a period of three or more years (DeCarli, 2003; Mosconi et al., 2004; Palmer et al,, 2007; Petersen et al., 1999; Tschanz et al., 2006). These rates are dramatically higher than those seen in healthy older populations (Boyle, Wilson, Aggarwal, Tang, & Bennett, 2006). Thus, diagnostic success in the preclinical stage and even in the presymptomatic phase has become crucial (Dubois et al., 2007). Initiating treatment in the early stages of MCI can reduce the risk of conversion to dementia and can thereby prolong the lives of patients. Neuropsychological tests are an effective way of evaluating changes in cognition and can be used as screening tools to assess cognitive performance and assist physicians in distinguishing between symptoms that represent normal aging and those that represent MCI. Recent research has demonstrated that some of these cognitive tests are particularly sensitive for detecting early cognitive impairment (Kalbe et al., 2004; Kramer et al., 2006; Nasreddine et al., 2005). For example, the Standardized Mini-Mental State Examination (SMMSE) is the most frequently used cognitive screening instrument and is efficient in detecting cognitive impairment (Gungen, Ertan, Eker, Yaar, & Engin, 2002; Ismail, Rajji, & Shulman, 2010; Kahle-Wrobleski, Corrada, Li, & Kawas, 2007). In addition, the Clock Drawing Test (CDT) (Kirby, Denihan, Brace, Coakley, & Lawlor, 2001; Schramm et al., 2002), the Verbal Fluency Test (VFT) (Hall, Harvey, Vo, & O'Bryant, 2011; McDowd et al., 2011), and the Three Words-Three Shapes Test (3W3S) (Weintraub et al., 2000) have been shown to be effective in predicting the changes that occur in early cognitive impairment. However, functional activity scores are also important diagnostic indicators because working memory deficits often result in patients encountering more difficulties in everyday activities than those seen in normal aging (Aretouli & Brandt, 2010). …

Therapeutic Uses of Rap and Hip-Hop. Susan Hadley and George Yancy (Eds.). New York: Routledge, 2012, 427 pages. ISBN: 978-0-415-88474-7, $34.95, paperback

Abstract: Therapeutic Uses of Rap and Hip-Hop. Susan Hadley and George Yancy (Eds.). New York: Routledge, 2012, 427 pages. ISBN: 978-0-415-88474-7, $34.95, paperback. Therapeutic Uses of Rap and Hip-Hop asks readers to examine their personal and professional perceptions of rap music and hip-hop culture to consider potential benefits across diverse therapeutic settings. This challenge cuts to the heart of "starting where the client is" by appreciating context--the roles of both music and culture in the lives of the clients with whom we engage--and our ethical responsibility to give clients a voice via a metaphoric microphone, or "one mic" (as the editors put it in their introduction). Susan Hadley and George Yancy suggest that culturally competent therapy must give one mic--an opportunity to be heard, a voice, ownership, empowerment, and cognizance of one's lived experiences. From this perspective, they contend that rap and hip-hop cannot be overlooked, undervalued, or blindly and wholly branded as violent, drug promoting, misogynistic, or sexually offensive. Instead, professionals working with those who embrace hip-hop culture must be able to appreciate rap's positive attributes, which are rooted in the importance of oral tradition. Specifically, this requires regard for Nommo, a Bantu term referring to the power of words to create change, redefine reality, and realize actualization (Smitherman, 1999); this is a powerful manner by which to give "one mic" and, therefore, holds a valuable place in therapeutic settings. The impressive backgrounds of both Hadley and Yancy bring strength to their argument, which not only suggests the use of rap music in therapy, but contends that it is "about as close to perfection as one can get to a therapeutic medium!" (p. xxvii). Hadley is a professor and director of the Music Therapy Program at Slippery Rock University and a board certified music therapist, and she has a lengthy history of research and publication in the areas of therapy, feminism, and race. Yancy, a three-time Choice Outstanding Academic Book award winner and associate professor of philosophy at Duquesne University, has published widely on the lived experiences of black people, or "Black Erlebnis." Both editors bring a great deal of expertise to Therapeutic Uses of Rap and Hip-Hop, as do their chapter contributors, comprising experienced music therapists, social workers, psychologists, psychiatrists, and psychotherapists. The 26 contributing authors of the 19 chapters of this volume are diverse not only in discipline, but also in their areas of clinical expertise; the characteristics of their clients; and their geographical locations, representing the United States, Canada, the United Kingdom, South Africa, and Australia. This variety brings divergent applications and perspectives, all of which share cutting-edge use of rap in therapy. Therapeutic Uses of Rap and Hip-Hop is divided into three parts: Part 1 provides a foundation by reviewing historical and theoretical perspectives, part 2 demonstrates applications of setting-specific rap therapies with at-risk youths, and part 3 illustrates diagnosis-specific rap therapies within varied client populations and clinical settings. In each section, chapter authors exemplify the benefits of listening, performing, creating, or improvising rap as a means of validation for those who find this medium significant in their lives. It is important to clarify the usage of terms within this book and this review. Although sometimes used interchangeably with rap, hip-hop refers to a culture and its related practices, among which rap music and its subgenres are components; therefore, the term "hip-hop" is used to refer to broader cultural approaches, whereas "rap" is used to refer specifically to musical applications and uses. Therapeutic Uses of Rap and Hip-Hop begins with an introductory chapter by the editors, who frame the book through the divergent lenses of their own personal and professional experiences, which converge as they both realize that rap is an integral medium for exploring identity, expressing feelings, understanding impulses, and storytelling and reauthoring--all of which highlight the importance of context in various therapeutic settings. …

Health Coverage for America: Signed, Sealed, and Delivered by the 2012 Election

Abstract: The century-long struggle to establish a national health insurance system ended on November 8, 2012, when Speaker of the House John Boehner (R-OH) told ABC News reporter Diane Sawyer on a live national television interview that "Obamacare is the law of the land," and there would be no more attempts by the House to repeal the Patient Protection and Affordable Care Act (P.L. 111-148) (PPACA). Republicans opposed the bill from the start and fell just one Senate vote short in their attempt to defeat it. Anger about the new law contributed to the Republicans' victory in the 2010 midterm elections, in which they won 63 House seas and regained the majority they lost to the Democrats in 2006. After President Obama signed PPACA into law in March 2010, the newly elected Republican majority in the House voted more than 30 times to repeal it, despite their knowledge that repeal would never pass the Democrat-controlled Senate. While the House majority was approving repeal bills, other opponents of the law sought relief through the judiciary. Multiple lawsuits were filed by state attorneys general alleging the law to be unconstitutional, and these suits appeared to be making some headway as lower courts split on the constitutionality of the "individual mandate" requiring nearly everyone to buy health insurance or pay a tax. The Supreme Court resolved the conflicting lower court decisions last June in yet another close vote when their five-to-four decision ruled against the 26 state attorneys general. Only after the reelection of President Obama, buttressed by Democratic gains in both chambers of Congress, did the Republican leadership finally throw in the towel. Opposition to PPACA stands on reasonably firm political ground when you examine the lukewarm popular support for the law. The Kaiser Family Foundation conducted 32 monthly polls between March 2010 and November 2012 that showed the country to be consistently divided on the issue. The percentage of the population holding a favorable opinion of the law ranged between 34 percent and 50 percent, whereas those holding unfavorable opinions had a nearly identical monthly range of 35 percent to 51 percent. In 23 of the 32 months, the unfavorables outnumbered the favorables (Kaiser Family Foundation, 2012c). Some argue that these polls do not really reflect PPACA's popular support. They point to other Kaiser surveys that have found broad endorsement for nearly all of the law's individual components when these were presented to survey respondents independently and not tied to PPACA (Kaiser Family Foundation, 2012a). Others note that some of the unfavorable opinions came from respondents who wanted the law to go further, but the larger truth is that the overwhelming political support enjoyed by programs like Medicare and Social Security has yet to materialize for PPACA. Deep-seated American ambivalence toward universal health coverage is 100 years old. In 1912, Teddy Roosevelt and his Progressive ("Bull Moose") party first proposed universal health care to the national electorate. With support of Jane Addams, who gave a seconding speech for Roosevelt's nomination, and some large corporations like U.S. Steel, Roosevelt's campaign was more successful than that of any other third-party candidate in U.S. history, garnering far more popular and electoral votes than the incumbent president, William Howard Taft, a Republican. However, Roosevelt lost this White House bid to Woodrow Wilson, a Democrat, and a credible call for national health insurance did not reemerge until the New Deal. Franklin Roosevelt initially included national health care in his Social Security legislation. However, he jettisoned that component of the bill when he deemed it politically unpalatable and a threat to enactment of his old age and unemployment insurance proposals (Physicians for a National Health Program, 2012). Attempts to enact national health insurance were revived under Harry Truman's Fair Deal after his election in 1948, when several of our European allies were creating national health care systems. …