Barriers Associated with the Implementation of an Advance Care Planning Program in a Prison Setting

Advance care planning is considered a best practice within health care. However, the extent to which planning occurs within prison settings is unknown. Through the course of implementing an advance care planning (ACP) program for aging and dying offenders at a medical classification center, multiple barriers were identified that need to be addressed systemically to ensure the medical wishes of offenders were known and honored. This article will outline the barriers and the steps that were taken to create systems change to promote and sustain advance care planning.     

Caregiving Youth Knowledge and Perceptions of Parental End-of-Life Wishes in Huntington’s Disease

Knowledge of patient end-of-life (EOL) wishes and discussions are vital for family caregivers, including children and youth who may be in caregiving roles (“young carers” or “caregiving youth”). However, little is known about caregiving youth awareness and perceptions of EOL issues. This study sought to explore caregiving youth knowledge of EOL wishes and their willingness for EOL discussions. Face-to-face interviews with 40 caregiving youth ages 10–20, who have a parent with Huntington’s disease (HD), provided information about their knowledge of the presence of their ill parent’s living will (LW) and durable power of attorney for health care (DPAHC), and willingness to talk with the parent about EOL choices and possibility of death. Less than one-half of the participants were aware of the parent’s LW or DPAHC. Content analysis revealed themes in reasons to want or not want EOL discussion with the parent: respect for the parent’s wishes, caregiving youths’ opinion not valued, and avoidance of EOL issues. Themes also included reasons to not want discussion with the parent about possibility of death: protecting the parent, parent in denial, parent not ready, and realization of the terminal outcome. Findings suggest HD patients and their caregiving youth need support for open EOL discussions, and could benefit from educational programs and support groups around EOL issues.     

Community Reentry and Older Adult Offenders: Redefining Social Work Roles

The number of older adults in US prisons continues to rise. In 2002, adults ages 50 and older made up 8% of the US prison population, up from 4% a decade prior. Many older offenders are released to communities that are poorly equipped to meet their special needs. and largely unprepared for the social and fiscal costs of their reentry. The focus of gerontological social work education on the returning older adult offender has been limited. This article examines social work roles in the community reentry/reintegration of older adult offenders. Best practices from the gerontological social work literature are presented and implications for social work practice are discussed.     

End-of-Life Preparations among Lesbian,Gay, Bisexual,and Transgender People: Integrative Review of Prevalent Behaviors

Proactively making end-of-life (EOL) preparations is important to ensure high quality EOL care. Critical to preparation is the discussion of preferences with one’s primary health care providers. Lesbian, gay, bisexual, and transgender (LGBT) people often experience discrimination from health care providers that will detrimentally affect their ability to communicate their care preferences. Structural barriers, such as those based on sexual orientation and gender identity, may impede timely and quality care when one is most in need. The aim of this study was to examine the prevalence of EOL preparatory behaviors among LGBT people, with particular focus on transgender individuals. Eight survey instruments with 30 prevalence estimates found in the literature were analyzed. EOL discussions between LGBT people and their primary health care providers were rare (10%). Transgender people were found to be even less prepared for EOL; they were 50–70% less likely than their LGB counterparts to have a will, a living will or to have appointed a healthcare proxy. A need exists for future mixed-methods research focused on LGBT populations accompanied by the cultural sensitivity needed to ensure their wishes are honored at the EOL.     

Current Inmate Expected Post-Release Needs and Perceived Barriers to Future Voluntary After-Care Program Attendance

When attendance in after-care programs that may help ex-offenders successfully reenter society is not a mandated condition of prison release, getting individuals to voluntarily attend these programs is challenging. In order to help social service agencies better encourage ex-offenders to participate in these programs, it is important to understand ex-offenders’ anticipated needs (thereby increasing possible motivation for attendance) and perceived barriers to program attendance prior to their actual release. Consequently, 256 individuals incarcerated in a county prison in northeastern Pennsylvania were surveyed to address these issues. Findings suggest that women, Hispanics, and parents of children under age 18 anticipate the greatest number of needs upon their future prison release. The most commonly anticipated post-release needs were obtaining food, clothing, education, and child care, although there are group differences. Regarding anticipated programing issues, all inmates foresee transportation barriers to post-release program attendance, and bus passes were the most preferred form of assistance. Scheduling and child care issues were also anticipated programing obstacles and were most pronounced for parents of young children, who report the greatest amount of anticipated needs but also the most barriers to voluntary post-release program attendance. Other group variations and programing implications for voluntary after care are discussed.     

Prison Welfare and Voluntary After Care

Summary Some findings of a survey into the experiences of men releasedfrom prison are reported, where they relate to their use ofprison welfare and after care services. These are discussedin the context of issues such as through-care, rate of take-up,and the factors which may be influential in determining whethera man makes use of after care on release from prison. It isproposed that for more isolated men the probation service shouldadopt a ‘reaching-out’ strategy.     

Life Prolongation Technologies in Home Care for the Frail Elderly

The imporfation of life prolongation technology from acute and chronic care institutions to the home has given rise to a range of challenges for the practitioner engaged in the delivery of gerontological home care services. The prominent programmatic and training issues are identified in an ethical context and approaches to improving home care staff practice skills are offered.     

Comfort with discussions about death,religiosity, and attitudes about end‐of‐life care

In end‐of‐life (EOL) care research, death anxiety and religiosity are often overlooked. Terror management theory (TMT) may provide a useful conceptual model with which to examine how comfort discussing death and religiosity influence attitudes related to EOL care. A telephone‐based survey was conducted among community‐dwelling adults in the Unites States. Via random sampling, with over‐sampling of Hispanics/African Americans, 123 completed survey interviews (response rate = 46%) were analyzed. Respondents were more likely to have better attitudes toward EOL care if they were older or white, religiously active, and comfortable with the subject of death. Religiosity and comfort discussing death were correlated with each other and remained significant predictors of attitudes about EOL care even without demographic covariates. Findings suggest that promoting an open dialogue about mortality may improve attitudes about EOL care and utilization of palliative care services. The study also provides evidence about the utility and applicability of TMT for EOL care.     

Ethical and psychosocial issues raised by the practice in cases of mistreatment of older adults

Intervention regarding older adult mistreatment raises many questions for practitioners. They have to interact with the victim, the abuser, and, in many cases, with both of them at the same time. In such cases, five themes emerge from the literature review on psycho-social and ethical issues in practice: practitioners' pre-construction and axiological frameworks, victims' capacity, confidentiality versus collaboration between practitioners or between agencies, social and family responsibilities and the balance between competing values in practice. Practitioners are well placed to offer a critical reflection on their practice and on ways of improving it. The goal of our qualitative study is to identify issues and ethical dilemmas in elderly mistreatment situations as represented in the discourses of practitioners in reference to interventions in their psychosocial practice. Sixteen practitioners from the public and community (non-profit organization) sectors were interviewed using a practice history approach. This paper presents the main ethical and psychosocial issues raised by practitioners and some ideas to improve the practice. It is motivated by the crucial question haunting the practitioners' minds: "How far should we go?"     

Monitoring the Monitors: Medicaid Integration of Passive Remote Monitoring Technology

Implementation of passive remote monitoring is advancing faster than our knowledge base about appropriate and ethical use. For all the media and research attention these technologies are getting, there has been very little discussion about how they are positioned to be integrated into health plans, yet their integration is key to how they will be incorporated into social work practice. As coverage of passive remote monitoring technologies expands in Medicaid home and community-based services (HCBS), new policies that support informed decision-making, consenting processes, and regulations for ethical, appropriate use are urgently needed. Research translation often trails policy, but the rapid development and implementation of technologies that passively collect and transmit new information about older adults call for a more responsive approach. In this commentary, I describe passive remote monitoring technologies, their implementation in Medicaid HCBS, and ethical issues. I conclude with specific suggestions for policy and practice to start addressing these issues.     

Co-Production and Self-Care: New Approaches to Managing Community Care Services for Older People1

A lack of management theory which is relevant to human service agencies, combined with a failure to recognize the very large contribution which older people make to their own care, makes it difficult to deliver supportive services effectively. Self care by elders is divided, in this preliminary classification, into new strategies for everyday living, the reallocation of time and the avoidance of risk. Managers who understand that service users are co-producers of care and recognize the need to manage the users, as well as their own staff and relations with other agencies, are more likely to be able to deliver good services. However the management of co-production is at present only theorized for the private sector where ethical issues are less pressing and users are customers. In future a greater understanding of co-production and the development of theory and practice which will combine the management of co-production with the empowerment of users within the public sector will be essential.     

社区服刑人员生活适应状况研究

本文以对河北省某市166名社区服刑人员调查数据为依据，从居住情况、经济收入和人际交往三个方面描述了社区服刑人员的生活适应状况。同时，用六个变量分别与该三个方面做交叉表并进行卡方检验，发现文化程度、婚姻状况、有无服刑经历和户籍对社区服刑人的生活适应有影响，性别与年龄没有影响社区服刑人员的生活适应。     

Treatment Utilization Among Metropolitan and Nonmetropolitan Participants of Corrections-Based Substance Abuse Programs Reentering the Community

ABSTRACT

This study examines differences in drug use and recidivism outcomes at 12 months postrelease from jail or prison as a function of geographic location and treatment utilization. Participants (N= 700) were previously enrolled in drug treatment during the last 6 to 9 months of their incarceration and were released to the community on either parole or serve-out. Findings from this study indicated that offenders returning to metropolitan areas reported more use of community treatment services following release than offenders in nonmetropolitan areas. Although offenders in both metropolitan and nonmetropolitan areas who reported community treatment following release were less likely to be reincarcerated, community treatment utilization was not a significant correlate of relapse. Findings are discussed, and future directions include favorable outcomes when community treatment is utilized.     

Gender Differences in Criminal Sentencing: Do Effects Vary Across Violent,Property, and Drug Offenses?*

Objective. Many studies find that females benefit from their gender in sentencing decisions. Few researchers, however, address whether the gender‐sentencing association might be stronger for some crimes, such as minor nonviolent offending, and weaker for other offenses, such as serious violent crime. Method. Using a large random sample of convicted offenders in Texas drawn from a statewide project on sentencing practices mandated by the 73rd Texas Legislature, logistic regression and OLS regression analyses of likelihood of imprisonment and prison length illustrate the importance of looking at sentencing outcomes not only in terms of gender but also in terms of crime type. Results. Specifically, we find that the effect of gender on sentencing does vary by crime type, but not in a consistent or predicted fashion. For both property and drug offending, females are less likely to be sentenced to prison and also receive shorter sentences if they are sentenced to prison. For violent offending, however, females are no less likely than males to receive prison time, but for those who do, females receive substantially shorter sentences than males. Conclusions. We conclude that such variation in the gender‐sentencing association across crime type is largely due to features of Texas' legal code that channel the level of discretion available to judges depending on crime type and whether incarceration likelihood or sentence length is examined.     

‘Poor prison flowers’: convict mothers and their children in Ireland, 1853–1900

Pregnant women and mothers were among the thousands of individuals who were sentenced to at least three years’ penal servitude and admitted to the nineteenth-century Irish female convict prison. While some babies were born behind bars, others were permitted to accompany their convicted mothers into the prison after the penal practice of transportation had ceased. Other dependent children were separated from their convicted mothers for years, cared for by family members or friends, or accommodated in Ireland’s growing web of institutions. Using individual case studies, this article focuses on convict mothers and their young offspring. It draws attention to the increasing restrictions on the admission of infants that were imposed as the nineteenth century progressed, the problems that children of various ages in the penal system seemed to pose for officials, and the difficulties faced by incarcerated mothers who wished to maintain communication with their offspring. This article argues that while there were benefits to parenting within the confines of the prison, sentences of penal servitude had a significant impact on the lives of dependent offspring by dislocating families, separating siblings, or initiating institutional or other care that broke familial bonds permanently. In so doing, the article reveals attitudes towards motherhood as well as female criminality and institutionalization generally during this period and sheds light on an aspect of convict life unique to the women’s prison.     

The Use of Imprisonment on Groote Eylandt

The island of Groote Eylandt, in the Gulf of Carpentaria off the coast of East Arnhem Land, has a rate of imprisonment far higher than that prevailing in other local government areas of the Northern Territory and more than 25 times the national rate. Groote Eylandt prisoners are predominantly young, unmarried, Aboriginal males who are likely to be unemployed, have low levels of educational achievement, are highly likely to have been in prison previously, are dealt with by the Magistrates Court for offences involving property or alcohol and are likely to serve actual prison terms of under one year. This paper suggests that the use of correctional facilities in Darwin and elsewhere has little deterrent effect for these offenders and recommends the establishment of a small correctional facility on Groote Eylandt.     

Ethics,Gender, and Ethnicity in Single-Case Research and Evaluation

Social work practitioners and students are now being encouraged to do single-case research or at least, to evaluate their practice outcomes objectively. Ethical issues in both endeavors, including issues related to clients' gender and ethnicity, need more attention than they have been given. This article explores a number of ethical issues in single-case research and evaluation, with special attention to possible gender and ethnic bias in selecting clients or target problems to monitor. Guidelines for reducing bias, seeking informed client consent, and use of human subjects review are proposed.     

The Grief Experience of Prison Inmate Hospice Volunteer Caregivers

Correctional institutions are obligated to provide end-of-life care to a population with complex medical needs. Prison hospices are increasingly being formed to address this demand. Few empirical studies have examined the impact of caring for dying inmates on the hospice inmate volunteers, who, in several prison health care systems, provide direct care. In this study, experiences of the inmate hospice volunteers with death were investigated to illuminate their grief processes. Understanding the bereavement needs of hospice volunteers and how prison hospice volunteers navigate grief and remain committed to providing excellent hospice care can inform the grief processes and practices of hospice care professionals.     

Homeless and financially dependent adolescents as clients of a family agency 1

A wide range of issues are explored that are identified by incarcerated mothers during their participation in a Family Reunification Group at a prison for women. They include concerns regarding parent–child visits; lack of communication by child welfare social workers, attorneys, foster parents, and other caregivers; the Adoption and Safe Families Act (ASFA); lack of finances; past and present unresolved trauma issues; and the absence of notification of scheduled court hearings. This article also provides an in-depth look at how a group therapist established a therapeutic alliance with varied women in the group over a period of 5 years (2008–2013) and maintained a sense of professional self in this controlled setting. Finally, the implications for clinical social work practice and social work education are presented. Confidentiality is ensured with the use of de-identified case composite clinical material.     

Inequalities in child welfare intervention rates: the intersection of deprivation and identity

Child welfare systems internationally exhibit very large inequalities in a variety of dimensions of practice, for example, in rates of child protection plans or registrations and out‐of‐home care. Previous research in the midlands region of England (Bywaters; Bywaters et al.) has detailed key aspects of the relationship between levels of neighbourhood deprivation and intervention rates. This paper reports further evidence from the study examining the intersection of deprivation with aspects of identity: gender, disability, ethnicity and age. Key findings include a decreasing gender gap and a decreasing proportion of children in need reported to be disabled as deprivation increases. The data challenge the perception that black children are more likely than white to be in out‐of‐home care, a finding that only holds if the much higher level of deprivation among black children is not taken into account. Similarly, after controlling for deprivation and age, Asian children were found to be up to six times less likely to be in out‐of‐home care. The study requires replication and extension in order that observed inequalities are tested and explained. Urgent ethical, research, policy and practice issues are raised about child welfare systems.