Using Photovoice to Identify Service Needs of Older African American Methadone Clients

ABSTRACT

This article presents findings from a photovoice project designed to identify service needs of older-adult African American methadone clients, as well as their current barriers to and supports for abstinence. The project involved 10 participants (aged 53 to 63 years old) recruited from a methadone maintenance program in a large Northeastern U.S. city. Thematic analysis techniques were used to analyze participants’ narratives of their pictures. Transportation emerged as a significant challenge to accessing services, and caregiving was a motivation for remaining abstinent. Future research should use similar participatory methods and engage a broader group of aging people struggling with substance abuse.     

Research with Older Adult Methadone Clients: The Importance of Monitoring Suicide Ideation

ABSTRACT

This study reports on the importance of monitoring suicide ideation among older adult research participants. A recently completed randomized controlled trial of older adults who are current clients in methadone maintenance treatment (MMT) served as a case study to elucidate a suicide protocol that was designed to account for the potential instances of suicide ideation within the research project structure. As the numbers of older adult heroin users increases, this study’s findings seek to influence research protocols that involve older adults with addictions who may be particularly vulnerable to suicide risk due to comorbid psychiatric conditions and psychosocial adversities.     

Patterns of deviant career in the history of female methadone clients: an exploratory study

The aim of this article is to describe the drug career of 71 severely opioid-dependent women who had a history of selling sex and were enrolled in methadone maintenance treatment. Data were collected through semi-structured interviews, from medical records and reports from social agencies and correctional institutions. The sequential pattern could be described in the following order: initiation of the first drug of abuse, opioid onset, initiation of selling sex, first non-methadone treatment episode, first sentence and, finally, methadone maintenance treatment. There were significant age differences and correlations between most of the events. The main correlation ( r = 0.70) was the one between debut of opioid use and selling sex, which was confirmed in a stepwise multiple regression analysis. In addition, a history of running away from home advanced the age at which the women started selling sex for those with an onset of opioid use at an older age than the mean of 18.4 years.     

Expanding the scope of research with transition‐age foster youth: applications of the social network perspective

The support and resources embedded in social networks may be especially important for youth aging out of child welfare custody, such that foster youth support network characteristics influence the degree to which individual risk factors translate to poor outcomes during the transition from care. To examine the extent of this network influence on youth outcomes, social network analysis can be used to measure the interconnected relationships in the service network of caseworkers, foster parents and other providers, and in the personal network of biological family and community supports. By assessing these patterns of relationships, researchers can identify social network characteristics associated with particular subpopulations of foster youth who experience relatively successful or unsuccessful transition outcomes. This paper applies social network concepts and related methodology to frame foster youth transition support from a network perspective and to promote the generation of network‐informed hypotheses that could expand the scope of research with this important population.     

Development,Feasibility, and Piloting of a Novel Natural Mentoring Intervention for Older Youth in Foster Care

Aging out of foster care is associated with deleterious emerging adulthood outcomes. The enduring presence of a caring adult, such as a natural mentor, can improve outcomes for emancipating foster youth. Caring Adults ‘R’ Everywhere (C.A.R.E.) is a novel, child welfare-based intervention designed to facilitate natural mentor relationships among aging-out youth. Our aims were to test the feasibility of implementing C.A.R.E. and the feasibility of conducting a randomized controlled study with older foster youth. Twenty-four foster youth aged 18–20.5 years were recruited and randomly assigned to the intervention (n = 12) or control groups (n = 12). Ten natural mentors were identified and contacted for participation in the intervention and study. Process-oriented qualitative data and quantitative pre- and postintervention outcome data were collected and analyzed. Utilizing a controlled rigorous design, the findings highlight the positive experience of both the intervention youth and their natural mentors with C.A.R.E. Overall, results support the continued refinement, delivery, and rigorous testing of C.A.R.E. with great promise for programmatically supporting natural mentor relationships among youth aging out of foster care.     

Inclusive foster care: How foster parents support cultural and relational connections for Indigenous children

How do foster parents support the relational and cultural connections of Indigenous children in care? The answer matters; the well‐being of Indigenous children depends on these connections. At one of Canada's largest Indigenous child welfare agencies, we implemented inclusive foster care, an approach requiring foster parents to engage with the family, community, and cultural life of the child for whom they care. Fifteen years later, we present findings from a thematic analysis of interviews with 13 foster parents who participated in a mixed methods study exploring inclusive foster care. We discuss foster parent strategies to support the child's family relationships: setting clear boundaries, rolling with inconsistency, and understanding the family's (hi)stories. Strategies to strengthen cultural connectedness include visiting traditional territory, using personal initiative and Indigenous knowledge, and engaging in school‐based and “multi‐purpose” cultural opportunities. Drawing on foster parent stories of success, we propose ways for social workers, foster parents, and policymakers to address the cultural and relational disruption that characterizes the experience of Indigenous children in care in colonial settler societies.     

An ecological systems approach to understanding social support in foster family resilience

Families who care for children in the foster care system often experience challenges related to the system, accessing services and supports, and managing relationships. Despite these challenges, many families thrive because of unique attributes and strengths that contribute to experiences of resilience. Using an ecological framework, this study examined social support among resilient foster families to better understand how foster caregivers experienced positive reciprocal transactions across systems. As part of a larger study, in‐depth narrative interviews were conducted to examine the process of resilience for families who foster. Findings revealed that families accessed and benefited from social support on micro‐level, meso‐level and macro‐level. Understanding how families cultivated social support across multiple levels offers implications for practice and policy when considering how best to retain and support families who care for vulnerable children.     

The Experiences of Reciprocity among Filipino Older Adults in Canada: Intergenerational,Transnational, and Community Considerations

ABSTRACT

This article illustrates the concept of reciprocity in the context of immigrant families. It recommends that definition of reciprocity account for exchanges beyond the immediate family, and render visible the simultaneous location of older people as care recipients and providers, and care arrangements across generations, borders, community, and time. Adopting a critical ethnographic study on the aging and care experiences of older Filipinos in Canada, this article analyzes data from extended observations and in-depth semi-structured interviews with 18 older people, 6 adult children, and 13 community stakeholders. Findings highlight the unique configurations of care among the Filipino community whereby older people engage in care exchange as active participants across intergenerational, transnational, and fictive kin networks.     

Voices of Resilience

Abstract

Terminally ill older adults have the capacity to live well in the context of dying. Having negotiated a lifetime of challenges, they have resources to demonstrate resilience and achieve wholeness in life's final phase, but research has not adequately investigated this process. This qualitative research study considered the paths to resilience used by 30 older adult hospice clients in Kansas and Illinois. Responses were coded using the grounded theory method of Strauss and Corbin (1990) where data drives interpretation and text is coded into categories. Results centered on four themes that included: (1) a redefinition of self; (2) use of religion/spirituality or openness to uncertainty; (3) maintenance of social investments; and (4) guarding independence even as the scope of life contracted. Results imply that attention should be paid to building environments of wellness. This may be accomplished paradoxically through facilitating continuity of client interests and yet opportunities for creativity and growth as well. Listening with a healing stance and cultivating a habit of being fully present in interactions with clients assist in this process.     

Voices of resilience: older adults in hospice care

Terminally ill older adults have the capacity to live well in the context of dying. Having negotiated a lifetime of challenges, they have resources to demonstrate resilience and achieve wholeness in life's final phase, but research has not adequately investigated this process. This qualitative research study considered the paths to resilience used by 30 older adult hospice clients in Kansas and Illinois. Responses were coded using the grounded theory method of Strauss and Corbin (1990) where data drives interpretation and text is coded into categories. Results centered on four themes that included: (1) a redefinition of self; (2) use of religion/spirituality or openness to uncertainty; (3) maintenance of social investments; and (4) guarding independence even as the scope of life contracted. Results imply that attention should be paid to building environments of wellness. This may be accomplished paradoxically through facilitating continuity of client interests and yet opportunities for creativity and growth as well. Listening with a healing stance and cultivating a habit of being fully present in interactions with clients assist in this process.     

Social Support,Retirement Resources,and the Gendered Experiences of Aging for Tunisian Older Adults

Cultural context plays an important role in the experience of aging. The country of Tunisia is of particular interest because limited studies on aging have been done in the past decade. The study examined data collected from Tunisian older adults in an attempt to gain additional information about their experience aging in this culture. The purpose of this study was to identify key information tied to social policy factors that have the potential to impact older adults living in Tunisia. From June to July 2017, semi-structured interviews were completed with 60 older adults covering topics about family history, daily activities, health and health satisfaction, retirement benefits and satisfaction, medical coverage, social support, service availability, feelings of growing older, as well as advice provided to younger adults. Findings include gender differences in retirement resources and benefits, sources of support, and older adults’ self-reported desires for the future. This work adds to the growing body of literature concerning differences in global aging and provides greater awareness of aging in the distinctive context of Tunisia. Additional work should seek to deepen the investigation of the various social policies that impact the Tunisian older adult.     

A Client Satisfaction Measure of Homecare Services for Older Adults

Client satisfaction can be used as an indicator for service quality. Without concrete feedback from clients, however, the usefulness of client satisfaction data for service improvement can be limited. This study described the development of a client satisfaction measure that can be used to provide concrete feedback for service providers. Based on a conceptual framework proposed in the literature, the Client Satisfaction: Home Care (CSAT-HC) uses a client-centered perspective to measure client satisfaction for homecare services for older adults. A survey of 200 older adults receiving homecare services provided by a social service agency in a large U.S. Midwest city was conducted to assess the psychometric properties of CSAT-HC. Results based on the 156 completed surveys show that CSAT-HC has good validity (correlation r = .62 with a popular client satisfaction measure) and test-retest reliability (r = .75). These results indicate that CSAT-HC is a valid and reliable client satisfaction measure; and therefore, providers of homecare services for older adults can use CSAT-HC to obtain client feedback for quality assurance or program evaluation purpose. Future research may use CSAT-HC to explore the potential influences of quality of homecare services on the well-being of older adult clients.     

In Their Own Words: Participants' Perceptions of the Impact of Adult Day Services

Despite the growth in the number of adult day services programs providing long-term care in the United States, researchers have struggled to consistently identify the benefits of the services to older adult participants. Instead of identifying participant outcomes driven by administrative databases, funding requirements or accreditation expectations, this study attempted to identify outcomes through the lived experiences of the older adult participants through one-on-one interviews after 3 months of attendance. The purpose of this qualitative study was to gain an understanding of the experiences of older adult participants and to build theoretical understandings that connect experiences with outcomes. Twenty-eight semistructured interviews were conducted with older adults attending 4 day health programs administered by 1 organization in a large mid-west City. Three main program experiences were identified: social connections with participants, empowering relationships with staff, and participation and enjoyment of activities and services. These experiences seemed to be associated with perceived improvements in psychosocial well-being and a perceived decrease in burden or dependence on the caregiver. The findings provide theoretical connections that are helpful for exploring the impact of adult day services based on participant perspectives. Results suggest a need for further examination of the role social workers play in supporting psychosocial services within adult day programs.     

Getting Started: An Empirically Derived Logic Model for Age-Friendly Community Initiatives in the Early Planning Phase

Age-friendly community initiatives (AFCIs) foster efforts across stakeholders to make localities more supportive and inclusive of older adults, and potentially better for residents of all ages. This study drew on in-depth interviews with leaders of nine newly forming AFCIs in northern New Jersey to develop an empirically based logic model for the initiatives in the early planning phase. The results obtained from a conventional content analysis indicated three main activities in the early planning phase: assessing the community; meeting; and communicating with stakeholders; and facilitating communitywide communications. These activities worked toward two outputs: increased understanding of aging in the community and more engaged stakeholders in aging. Participants described leveraging the contributions of lead staff, consultants, elected officials, organizational partners, volunteers, interns, funders, and other AFCIs to engage in their focal activities. Based on these findings, a logic model for AFCIs in the early planning phase is presented. AFCI leaders can draw on this model to evaluate AFCI processes and outcomes in their formative stages, as well as to strategically plan for the start of an AFCI within a given locality. Findings also suggest important directions for future research on the development of AFCIs and the community changes that they seek to influence.     

Community-Based Disability Prevention Programs for Elders: Predictors of Progam Completion

Strategies to foster elder well-being and reduce long-term care costs include efficacious community disability prevention programs. Program completion remains an important barrier to their effectiveness. We examined the association between provider relationships and client variables, and program completion in senior centers. Our mixed methods design used secondary data for 719 clients and primary data through telephone interviews with 20 nurses, 23 social workers, and 18 site managers. Quantitative data showed that higher client baseline self-efficacy positively influenced completion and minority status negatively influenced completion. Qualitative data showed that higher focus on provider-client relationships was associated with high completion.     

‘Growing Old’ in Shelters and ‘On the Street’: Experiences of Older Homeless People

Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.     

Substance use among older youth transitioning from foster care: Examining the protective effects of religious and spiritual capital

Among older youth transitioning from the foster care system, this longitudinal study examined the association of religious and spiritual capital to substance use in the past year at age 19. Participants consisted of African American (N = 179) and White non‐Hispanic (N = 133) older youth in foster care. Drawing from social capital theory, it was posited that religious service attendance (a proxy for religious capital) and belief in a spiritual force (a proxy for spiritual capital) would be inversely associated with substance use. Multiple logistic regression results indicated support for the first and second hypothesis for White foster youth only. Among White foster youth, more frequent religious service attendance and greater belief in a spiritual force were associated with a lower likelihood of illegal substance and polysubstance use. No association between religious or spiritual capital and substance use was found among African American foster youth. The findings underscore the importance of conducting spiritual assessments to help ensure older foster youth who have strong religious or spiritual orientations are in environments where they are accommodated and supported.     

Practices of activation in frontline interactions: Coercion,persuasion, and the role of trust in activation policies in Germany

Following Michael Lipsky's well‐known argument that policy is made in the daily encounters between street‐level bureaucracy and citizens, a growing body of research emphasizes that actors and organizations delivering social and labor‐market policy play a crucial role in welfare‐state politics. Using qualitative data collected at three local employment agencies in Germany, this article explores worker‐client relations as a crucial mechanism through which activation policies are translated into practice. The analysis investigates how caseworkers define their role and their relationships with clients. The findings show that it is essential for caseworkers to achieve client compliance. In such a context, building relationships of trust is a strategic instrument in overcoming possible barriers to co‐operation in the caseworker‐client interaction. Caseworkers develop strategies to create the impression of trustworthiness and to motivate both unemployed clients and employers to become trust‐givers in the caseworker‐client relation. While research has often stressed the dichotomy between disciplining and enabling elements of activation policies, our explorative study shows that persuasion and trust‐building are a further important dimension of the frontline delivery of activation policies. These strategies reflect the importance of emotional aspects of frontline work.     

“As Needed” Case Management Across Aging Services in Response to Depression

A lack of clarity on how and where case management for older adults is delivered persists, even as evidence supports its use to respond to depression. We used in-depth interviews with managers (n = 20) and staff surveys (n = 142) from 17 service agencies to explore the provision of case management services in adult day services, homecare, senior centers, and supportive housing. Limited case management services were found. Barriers included limited time and resources, especially for senior centers and supportive housing. Results revealed a concern about the role, feasibility, and availability of case management for older adults within these settings.