Setting priorities in aging populations: formal service use among Mexican American female elders

This study establishes empirical patterns of formal service use by a sample of 483 elderly Mexican American women, and identifies the predictors of formal service utilization. Results indicated two patterns of service use-in the home and at senior centers. Regression analysis demonstrated that the best predictors of who used formal in-home services were those with functional impairment in Instrumental Activities of Daily Living (IADLs) and those with the least amount of assistance with IADLs provided by family members. Living alone and attending group social events were the best predictors of the use of senior center services. Anticipated changes in the Mexican American population portend a growing need for both in-home and senior center services. These findings can be used to establish policy and programming priorities for this neglected population. If resources are to be effectively targeted to frail elders, in-home services should receive priority, and the provision of in-home services should be modified to include additional programs that facilitate care of the elderly by the family.     

Perceived Need for Home- and Community-Based Services: Experiences of Urban Chinese Older Adults With Functional Impairments

Guided by Cantor’s social care model, this study identified individual, family, and social support factors that influence urban older adults’ need for home- and community-based services, including medical and rehabilitation, instrumental care and support, and psychosocial services. The data were extracted from the Sample Survey on Aged Population in Urban/Rural China conducted by the China Research Center on Aging in 2006. Results from multiple logistic regression show that older adults’ need for medical and rehabilitation services is significantly related to instrumental activities of daily living, depression, not having filial children, friend support networks, and having a confidant. Older adults’ need for instrumental care and support is related to their educational attainment, financial strain, instrumental activities of daily living, not living with children, and friend support networks. Finally, older adults’ need for psychosocial services is significantly related to educational attainment, depression, not being married, friend support networks, and having a confidant. Implications for social service development are discussed.     

In-home family therapy: indicators of success

In this study, we explore how specific individual, family, and family-within-community characteristics, as well as aspects of in-home family therapy, relate to responses to treatment. The Child and Adolescent Functional Assessment Scale scores and Global Assessment of Functioning scores were used as outcome measures. Results revealed significant differences between pre- and post-scores for clients receiving in-home family therapy services, providing an initial indicator of treatment success. In addition, primary family caregiver social support, role performance in school/work, and self-harmful behavior were indicative of successful outcomes. Clients with higher problem levels had the greatest rates of change, and clients receiving more hours of services fared better in therapy.     

The influence of caregiving stressors, social support, and caregiving appraisal on marital functioning among African American wife caregivers

Using a stress and coping framework, we examined the influence of caregiving stressors, social support, and caregiving appraisal on the marital functioning of 100 African American wife caregivers. Results of separate multivariate analyses revealed received church support, caregiving burden, and caregiving satisfaction significantly predicted wives' marital functioning, when caregivers' background characteristics (age and education), length of caregiving, whether first marriage, and urban versus rural location were controlled. Receiving church support was associated with increased marital functioning. Lower levels of caregiving burden were associated with increased marital functioning. Higher levels of caregiving satisfaction were associated with increased marital functioning. Findings illuminate wives' caregiving and marital experiences, and have implications for family therapy and future research.     

Expansion of formalized in-home services for Japan's aged

This article analyzes the social and political forces in Japan that led to the creation of the Gold Plan, a comprehensive national plan for formalized in-home services for the aged. The political strategies of the Gold Plan are examined from the following perspectives: (1) shifts from institutional to in-home services, (2) decentralization of in-home services policy, and (3) needs for expanding the number of in-home service workers. New nonprofit organizations called Resident-Participation Types (RPTs) are identified, which are self-help organizations to augment the delivery of in-home services to the aged. The current status of these new models for the aged are examined, using data from two different surveys conducted by the Japanese National Council of Social Welfare in 1992 and 1993. Finally, future issues regarding RTPs and in-home services for the aged and some policy recommendations are discussed.     

Expansion of Formalized In-Home Services for Japan's Aged

This article analyzes the social and political forces in Japan that led to the creation of the Gold Plan, a comprehensive national plan for formalized in-home services for the aged. The political strategies of the Gold Plan are examined from the following perspectives: (1) shifts from institutional to in-home services, (2) decentralization of in-home services policy, and (3) needs for expanding the number of in-home service workers. New nonprofit organizations called Resident- Participation Types (RPTs) are identified, which are self-help organizations to augment the delivery of in-home services to the aged. The current status of these new models for the aged are examined, using data from two different surveys conducted by the Japanese National Council of Social Welfare in 1992 and 1993. Finally, future issues regarding RTPs and in-home services for the aged and some policy recommendations are discussed.     

Emergence of social support networks among breast cancer survivors through a community-based physical activity program in Colombia

Physical activity (PA), social networks, and social support have been associated with decreased mortality and improved quality of life among breast cancer survivors (BCS). This study used social network analysis to understand the social co-benefits of a community-based PA program for BCS in Colombia. Two types of social support networks emerged from the program: friendship (the number of edges increased by 90 %) and PA support (35 % of participants practiced PA together after the program). Using egocentric and socio-centric analysis we show the presence of homophily for friendship and PA support relations and the BCS’s roles in their networks.     

Social support characteristics among nonclinical African-American and Filipino-American parents with school-age children

This study is the first phase of a project to develop a culturally-appropriate, family-mediated social support intervention program. This phase consisted of in-home interviews with 26 African-American (AF) and 26 Filipino-American (FA) parents who were not receiving counseling or social services for parent-child conflict, and self-reported adequate personal and family functioning. In general, parents were college educated and employed full-time and had house-hold incomes of over $25,000. On average, AF parents were 35 years old, with 4 people in the household, including 2 children (mean AGE = 10 years). FA parents were older, averaging 45 years, and had 6 people in the household, including 3 children (mean AGE = 12 years). Mean scores on standardized measures reflected high self-esteem and positive attitudes toward their children and families. Social network size averaged 32 and 38 members for AF and FA mothers respectively, and 24 and 29 members for AF and FA fathers. Most parents reported that fewer than 50% of their network members knew each other. Data also suggested that parents reported a generally positive orientation to utilizing support resources, and favorable perceptions of and satisfaction with support form family and friends. Analyzes revealed that only functional support variables were significantly associated with parent well-being. Study limitations, service implications, and further research directions are discussed.     

Depression and Religiosity in African American and White Community-Dwelling Older Adults

SUMMARY

This research examined the extent to which religiosity was predictive of level of depression, even after controlling for race, gender, social support, income sufficiency, and physical health. Data were collected using in-home interviews conducted from 1999 to 2001 with 1,000 adults age 65 to 106. Subjects were recruited from a stratified, random sample of Medicare beneficiaries age 65 and older in five central Alabama counties (three rural and two urban). The sample was stratified by county, race, and sex and included balanced numbers of African American males and females and White males and females. Highly religious persons had lower levels of depression, even when controlling for other known covariates, β = -.16, t(972) p < .001. Females reported higher levels of depression, β = .07, t(972) p < .05. Although race was unrelated to depression in the model including gender and religiosity only, African Americans reported fewer symptoms of depression than did Whites when social support, income sufficiency, and physical health were added to the model, β= -.08, t(972) p < .01. Results suggest the importance of health and social service professionals' drawing upon older adults' positive spirituality in professional interventions to prevent and treat depression.     

Promoting birth parents' relationships with their toddlers upon reunification: Results from Promoting First Relationships® home visiting program

Birth parents, once reunified with their child after a foster care placement, are in need of in-home support services to prevent reoccurrence of maltreatment and reentry into foster care, establish a strong relationship with their child, and enhance child well-being. Few studies have addressed the efficacy of home visiting services for reunified birth parents of toddlers. This study reports on the findings from a randomized control trial of a 10-week home visiting program, Promoting First Relationships® (Kelly, Sandoval, Zuckerman, & Buehlman, 2008), for a subsample of 43 reunified birth parents that were part of the larger trial. We describe how the elements of the intervention align with the needs of parents and children in child welfare. Although the sample size was small and most of the estimates of intervention effects were not statistically significant, the effect sizes and the pattern of results suggest that the intervention may have improved both observed parenting sensitivity and observed child behaviors as well as decreased parent report of child behavior problems. Implications are that providing in-home services soon after a reunification may be efficacious in strengthening birth parents' capacity to respond sensitively to their children as well as improving child social and emotional outcomes and well-being.     

Physicians and clergy as facilitators of formal services for older adults

Researchers have sought to understand the determinants of the use of in-home and community-based services in order to better serve the needs of older adults. One component frequently included in formal service utilization models is the role of individuals who exert an influence on the service use process. An analysis of in-depth interviews conducted with 115 older adults revealed the important facilitating role that physicians and religious leaders play in encouraging the use of these services. The sample, which included African-American and white adults age 65+ from rural and urban environments, described various ways in which these "facilitators" influence the use of formal services. These ways include: (1) supplying instrumental support either by "ordering" a particular program for or linking the elder with the program and (2) providing informational and affective support, including advising or recommending the use of a program, conveying necessary background on formal services, and legitimizing the use of formal services. Regardless of personal characteristics (such as ethnicity and residence), a majority of elders in the sample recognized the important role played by physicians, and clergy. The acknowledgement of the role played by these facilitators should be viewed as an opportunity for physicians and clergy to enhance the knowledge and appropriate use of needed formal services for elders. In addition, these findings have policy implications for the current provision of aging services.     

Social Support, Traumatic Events, and Depressive Symptoms Among African Americans

Structural equation modeling was used to examine the relationships among stress, social support, negative interaction, and mental health in a sample of African American men and women between ages 18 and 54 (N = 591) from the National Comorbidity Study. The study findings indicated that social support decreased the number of depressive symptoms, did not mitigate the effects of stress, and was reduced in response to financial strain. Financial strain and traumatic events were associated with increased negative interaction with relatives and depressive symptoms. The findings verify that stressful and traumatic events have direct influences on levels of depressive symptoms and affect the quality of social interactions and suggest how social interaction processes contribute to mental health.     

Acculturation,Premigration Traumatic Experiences,and Depression Among Vietnamese Americans

Summary

This study investigated the role of acculturation as a potential mediator or moderator for premigration traumatic experiences (PTE) and depression. The mediator effect refers to an effect in which acculturation mediates the negative impact of PTE on depression. On the other hand, the moderator effect signifies an interaction effect in which acculturation buffers the impact of PTE on depression. In other words, the negative impact of PTE on depression is hypothesized to vary according to different levels of acculturation. These two competing hypotheses were tested in a community-based sample of 261 adult Vietnamese Americans aged 25 and over. The sample consisted of 48% males and 64% of the sample were married. The average length of residence in the U.S. was 7 years. Multiple regression analyses did not support the mediator effect of acculturation, but did support its moderator effect as a buffer of PTE. Specifically, PTE had a much stronger effect on depression among those with lower levels of acculturation than those with higher levels of acculturation. Implications for future research and clinical practices are discussed.     

An Examination of the Woodwork Effect Using National Medicaid Long-Term Services and Supports Data

A common concern in long-term services and supports (LTSS) policy is the “woodwork effect,” which has two components: (1) more people will use publicly funded services if access to home- and community-based services (HCBS) is expanded; and (2) the additional beneficiaries will increase the growth rate of LTSS expenditures. Medicaid LTSS beneficiary and utilization data starting in 1999 indicate modest growth in beneficiaries and expenditures, after adjusting for inflation and the number of people with functional impairments. The data do not provide strong evidence that the shift in Medicaid funding toward HCBS significantly increased or decreased overall Medicaid LTSS spending.     

Do Disabled Elderly Medicare Beneficiaries with Major Depression Make Less Use of a Consumer-Directed Home Care Voucher Benefit?

Older adults with major depression may underutilize consumer-directed long-term care. Systematic underutilization would create disparities in outcomes, undermining program effectiveness. The Medicare Primary and Consumer-Directed Care Demonstration included a consumer-directed indemnity benefit that paid for goods and services not financed by traditional Medicare. Overall and for most categories of goods and services there was little difference in use and expenditures between those with and without major depression. However, among those using the benefit to hire in-home workers, arguably the most important consumer-directed purchase, average spending for workers was about 30% lower for depressed persons. While our findings are generally reassuring for public policy, future research is needed to verify that major depression is associated with less spending on in-home workers.     

Mental health outcomes among child welfare investigated children: In-home versus out-of-home care

BackgroundChild welfare has increasingly focused on alternatives to out-of-home (OOH) placement. In-home services, such as parent training, have increased and more maltreated children remain in-home. Yet, little is known about the effect on mental health of maintaining vulnerable children in-home vs placement in stable OOH care.ObjectiveTo evaluate and compare difference in mental health among children investigated by child welfare and who remained in-home vs. those who were placed in stable OOH care.Design/methodsWe examined a cohort of children (aged 1.5–18 years) from a nationally representative sample of children investigated by child welfare using the National Survey of Child and Adolescent Well-Being II (NSCAW II). We compared changes in mental health functioning over 18 months for children who remained in-home with parent training versus those placed in stable OOH care.ResultsAmong the 749 children in our sample, baseline characteristics of children who remained in-home with parent training and those placed in stable OOH care were similar. Among school-aged children placed in stable OOH care, mental health problems decreased from 26% to 13% (p = .003). This differed significantly from school-aged children who remained in home, for whom mental health problems increased (50% decrease stable OOH care vs. 23% increase in home; p = .007). Among pre-school aged children, mental health problems increased in both settings, particularly stable out-of-home care (p = .008).ConclusionsFor school aged children with a history of maltreatment, mental health outcomes improve following stable OOH placement, yet worsen when remaining in-home with parents. Pediatricians should be watchful for mental health problems among children who remain home after maltreatment and should advocate for high-quality stable OOH care when it is necessary. Child welfare may need to monitor the outcomes of children remaining at home more closely and provide more intensive preventive and treatment services to families.     

BEYOND THE CLINIC: IN-HOME THERAPY WITH HEAD START FAMILIES

Social workers and case managers have provided in-home services to families for some time. The field of Marriage and Family Therapy, however, has begun to do in-home work only recently. This paper describes the experiences of MFT interns who worked with families in their homes. Two university graduate MFT training programs conceptualized and practiced in-home therapy with families who had at least one child enrolled in the local Head Start program. This collaborative effort was part of the AAMFT-Head Start Training Partnership Project that had the goal of funding projects that demonstrated successful partnerships between MFT and Head Start. Six interns worked with 27 Head Start families in their homes. A model of the interns' transition from clinic-based to home-based therapy is discussed and applied to working with Head Start families. The framework of in-home therapy is expanded to conceptualizing larger systems and community-based interventions, and recommendations for family therapists in private practice and agency settings are made.     

Sexual functioning in women with chronic pelvic pain: the impact of depression, support, and abuse

Many studies have documented associations between sexual functioning, depression, experiences of childhood sexual abuse, relationship support, and chronic pelvic pain, but none have addressed the interrelationships among all of these variables in a unified model. The aim of this preliminary study was to construct an integrative model predicting sexual functioning for women with chronic pelvic pain. Sixty-three women with chronic pelvic pain completed measures of sexual functioning for use as the criterion variable, and measures of the impact of chronic pain, depression, experiences of sexual abuse, and relationship support as predictors. The primary finding was that depression mediated the effects of child sexual abuse and partially mediated the effects of relationship support on sexual behavior and satisfaction with the sexual relationship. In addition to its indirect relationship through depression, relationship support also independently predicted sexual function. Thus, in this nonclinical sample, the effects of child sexual abuse on sexual function depended on the extent of depressive symptoms, while the influence of relationship support depended in part on depression.     

Strengthening home and community-based care through Medicaid waivers

States are increasingly using the Medicaid 1915c waiver program to provide community-based long-term care (LTC). We examined state predictors of waiver utilization and expenditures for waivers serving both older and working-age individuals. State level data for the period 1992 to 2001 were used to estimate random effects panel models. States with increased community-based care (e.g., home health agencies) and decreased nursing home bed capacity were positively associated with state per capita rates of use, expenditures, and the share of Medicaid LTC dollars supporting 1915c waivers. States appeared to substitute Medicare for Medicaid services for individuals eligible for both. State per capita income was positively related to each measure. State policies that facilitate decreased institutional and increased community- based capacity appear essential to state efforts to expand access to community-based services. Federal policies that address state resource issues may also spur growth in community-based LTC, which, in most states, continues to be limited.     

Coping and Psychological Distress Among Genderqueer Individuals: The Moderating Effect of Social Support

This study examined the relationships between social support, coping, depression, and anxiety in a sample of genderqueer individuals (n = 64). Genderqueer is a label used within the broader transgender community and is defined as a gender identity that is outside the binary construct of male and female. Findings indicate that 53% (n = 34) of participants reported clinical levels of depression and 39% (n = 25) reported clinical levels of anxiety. There was a direct relationship between social support and depression and anxiety, indicating that more social support is associated with less depression and anxiety when statistically excluding coping factors. In addition, more facilitative coping (e.g., seeking help) was related to less anxiety, whereas more avoidant coping (e.g., avoiding emotions) was related to more anxiety and depression. There was a significant interaction between social support and coping factors when predicting anxiety, such that individuals who reported higher social support used more facilitative coping which was associated with less anxiety and those who reported less social support used more avoidant coping which was associated with more anxiety. Clinical implications for working with genderqueer-identified clients are discussed.