Gender Identity and Social Services: Barriers to Care

ABSTRACT

Transgender people seek social services for a variety of reasons. This literature review highlights needs assessments and social science research articles (N = 30) from the last 16 years that demonstrate the many ways in which social services are further revictimizing transgender people. Studies indicate that transgender people often encounter ignorance, hostility, and transphobic environments while attempting to access social services, and these environments can dissuade transgender people from gaining needed care. Suggestions are made to address these inequalities and include simple measures that social service agencies can begin with to make their services more transinclusive. Future research should address the bias in social services more directly and also develop a clear plan of action and best practices to help agencies remove discrimination from social service settings.     

Gender Identity Disorder,the Gender Binary,and Transgender Oppression: Implications for Ethical Social Work

This article argues that social workers are ethically obligated to serve as allies of transgender and gender-nonconforming communities and, thus, should critically examine the diagnosis of gender identity disorder and the oppression inherent in pathologizing gender nonconformity. Social workers should also consider the oppression inherent in the socially constructed gender binary that is the root of the perceived psychosis in gender nonconformance and should fight against this oppression and, therefore, against that binary. This article proposes several action steps that social workers can take to advocate for the transgender and gender-nonconforming communities.     

Challenges of Depression and Suicidal Ideation Associated With Aging With HIV/AIDS: Implications for Social Work

As the number of older adults with HIV/AIDS increases, new challenges are emerging that threaten their ability to age with this disease. Threats of particular concern are depression and suicidal ideation. Studies show that those aging with HIV/AIDS have a number of stressors that tax their coping mechanisms, increasing vulnerability to depression and suicidal ideation. These stressors can be categorized into three areas. First, there are psychosocial stressors that can contribute to depression. Second, there are health and biochemical stressors that can contribute to depression, as well as compromise cognitive abilities needed to adapt to such stressors. Third, cognitive stressors may create predispositions to depression. In particular, certain cognitive abilities needed to cope with depression and suicidal ideation may be compromised by aging with HIV/AIDS. A model of these stressors is provided for didactic purposes, as well as to suggest implications for social work practice and research.     

Perceived Challenges to the Sustainability of Community-Based Aging Initiatives: Findings from a National Study of Villages

Concerns have been raised regarding the sustainability of Villages, a rapidly-expanding set of organizations that typically use a participant-directed approach to improve older adults’ quality of life and ability to age in place. Using online survey and telephone-interview data from a 2013 follow-up study of Villages across the United States, this study examined organizational leaders’ perceptions of the major challenges to sustainability. Major challenges identified included: (a) funding, (b) membership recruitment, (c) leadership development, (d) meeting members’ service needs, and (e) limitations of the Village model itself. Findings point to a number of important considerations for the development, implementation, and sustainability of the Village model, including the role of social workers in addressing these challenges.     

Capturing gendered aspects of active aging in China: Insights drawn from the Active Aging Index in comparison with EU countries

This paper extends the Active Aging Index (AAI) to China to measure active aging among men and women over the age of 55. The strength of the AAI approach lies in its selection of a dashboard of multidimensional indicators of active aging, which are then aggregated into composite measures. The analysis used here considers the differences between men and women on 22 AAI indicators and their aggregations. China scores high on the first domain of the AAI (employment), is comparable with the EU countries on the second (participation in society), and scores lower on the third and fourth domains (independent and health living, and capacity and enabling environment). China has one of the largest gender gaps in active aging, especially in employment, but also in the domain of “Independent Living.” The comparison with EU countries points to a number of policy priorities and learnings, including the removal of disincentives to women working longer, namely differential mandatory and occupational retirement ages, and the introduction of measures to make workplaces more age and gender friendly.     

The Meaning of Gender While Aging With Paralytic Polio

The purpose of this article is to report the influence of gender on aging with childhood onset paralytic polio. The hermeneutic phenomenological exploration of gender was done using multiple qualitative interviews with 25 women, age 55 to 75 years of age, who had polio since before 14 years of age. We noted three themes: (a) the movement of her body, (b) integrating body and gender, and (c) gender discrepancies. Findings are discussed in the context of gendered expectations and the women's bodies.     

Hardiness,Successful Aging,and HIV: Implications for Social Work

ABSTRACT

With dramatic developments in the treatment of HIV/AIDS, life expectancy is increasing, resulting in more middle-aged and older adults living with this disease. Little is known about the problems, and especially the strengths, of those living and aging with HIV. Hardiness is used in the gerontological literature to describe and explain how people age successfully, despite traumatic life events and chronic diseases. Similarly, the concept of hardiness may be used to guide clinicians, researchers, and clients on how to age successfully with HIV. This article provides a review of hardiness in aging and HIV, and emphasizes its importance in facilitating successful aging with this disease. Conceptual and methodological concerns in studying hardiness and successful aging are addressed. Potential interventions and clinical implications for social work are posited for augmenting qualities of hardiness in people aging with HIV.     

Perceptions of Difference Between Aging and Disability Service Systems Consumers: Implications for Policy Initiatives to Rebalance Long-Term Care

This study explores service professionals' perceptions of how and why older adults and younger persons with disabilities are different consumers and clients within the long-term care service sector. Data are from 2004, early in the history of federal long-term care rebalancing initiatives, reflecting perceptions at that time. Findings suggest professionals working within aging, developmental disability, and physical disability service networks believe significant distinctions exist related to age of clients and nature of service required and how it is delivered. Overall need for greater professional and organizational capacity to support provision of service to both aging and disability populations is reported.     

关于中国人口老龄化的理论思考

人口老龄化是人类社会发展的历史必然,而中国人口老龄化进程的特殊性在于中国的加速老龄化是自觉的历史选择。对中国人口老龄化有诸多隐忧无可厚非,但中国应对老龄化也存在后发优势。社会经济的发展、科技的进步、平均寿命的延长使得中国可以克服应对老龄化的悲观思维。为此,我们需要更新发展观念,重新认识老年人价值,调动全社会的积极性,制定应对老龄化的战略。     

The experience of gender dysphoria for pre‐pubescent children and their families: a review of the literature

In recent years, the experience of gender dysphoria has gained public prominence through an explosion of sensationalized interest in the popular media. However, childhood gender dysphoria remains poorly understood and both parents and children often find themselves having to educate professionals around them. This not only creates a sense of disconnect between family and professionals, but also means that social workers can often be unaware of the myriad of competing perspectives that seek to explain gender variance. This review of the literature seeks to provide interested social workers with an overview of gender dysphoria, current research in the field and theoretical paradigms, with a view to promoting understanding and better practice with families in this little understood field.     

The Forgotten: Dementia and the Aging LGBT Community

Although research documenting the experience of lesbian, gay, bisexual, transgendered (LGBT) aging in general is gaining traction, and literature on dementia continues to proliferate, few articles attend to how dementia affects members of the aging LGBT community. This article reviews the current state of knowledge on the experience of dementia for LGBT older adults, and suggests areas for further research. In addition, it aims to promote social work’s engagement with related disciplines and global dementia care. The article’s ultimate goal is to encourage development of care practices tailored to the experiences, expectations and needs of older LGBT individuals affected by dementia.     

Rhetoric to Action: A Study of Stakeholder Perceptions of Aging Well in Two Local Communities

This qualitative study of local perceptions of policy goals and action in relation to aging reports 31 stakeholder interviews within 2 Australian communities exploring (a) the meaning of aging well; and (b) preferred policy actions to achieve positive aging outcomes. Findings suggest that community perceptions of aging well are broadly consistent with the goals of national and international policy frameworks in focusing on 3 dimensions—health, social engagement, and security. Further, participants believe that achievement of positive aging outcomes requires a mix of self-help, community action, and government intervention—particularly government support and encouragement for aging well initiatives.     

Daughters as Caregivers of Aging Parents: The Shattering Myth

A review of the history of de-institutionalization is given. The problem today for the older chronic former mental hospital patient is described. A protective services model is then proposed for these ex-mental hospital patients. The proposed model follows those that were developed to help older persons who become impaired to remain in the community. This model recommends that a careful assessment be made of the patient's ability to manage his/her life prior to discharge and that a service plan be developed from the assessment. Then the community agency, preferably the community mental health center which is already mandated this duty, assumes responsibility for planning and service to the patient. This service assures that patients are receiving the basic necessities and superviser their general welfare.     

Awareness of Resources for Visually Impaired Older Adults Among the Aging Network

Approximately 13% of the older adult population have severe near, intermediate and/or distance vision impairment. However, there is little recognition within the aging network that vision impairment among older adults can lead to isolation and excess disability. This article reports on a survey conducted by the Lighthouse National Center for Vision and Aging of the State Units on Aging (SUA) and Area Agencies on Aging (AAA) to assess their awareness of the vision rehabilitation network of services, their perceived need for more information on age-related vision loss and to identify specific projects known to or within the aging network addressing the needs of visually impaired older adults. Among the 298 respondent AAAs, 74% could identify at least one resource for visually impaired people, usually a segregated service offered exclusively to blind/visually impaired older adults. Eighty-three percent of the AAA respondents felt they needed to have more information on age-related vision impairment. The sparsity of programs within the aging network to address needs of visually impaired older persons is documented and discussed.     

Aging in Poverty: Making the Case for Comprehensive Care Management

A model for holistic care management that would enhance outcomes for economically vulnerable older adults who receive an array of disjointed services administered through the older Americans Act (OAA) and local Area Agencies on Aging (AAA) is proposed. Fragmented service delivery is typically wasteful and ineffectual, but comprehensive care management that includes an autonomous care manager, a single interagency plan of care and ongoing monitoring that is client-centered may protect those aging in poverty from negative health outcomes.     

End of Life,Chronic Illness,and Trans-Identities

In this study, the experiences and needs of a sample of 1,963 current, global, English-speaking, transgender-identified adults responding to the Transgender MetLife Survey (TMLS) as related to a number of later-life and end-of-life (EOL) preparations and concerns were examined. EOL concerns are integrated with concerns and challenges around chronic illness and disability. Overall, this population was significantly ill-prepared for the major legalities and events that occur in the later to EOL time periods. The population was found to harbor significant fears around the future. Drawing on the author's decades of survey research in transgender aging and case data along with current scientific and online literature, illustrative quotations and case examples are provided.     

Lesbian and Gay Elders and Long-Term Care: Identifying the Unique Psychosocial Perspectives and Challenges

This qualitative study of lesbian and gay elders seeks to identify the psychosocial challenges this community faces regarding long-term care. Two focus groups were conducted among 16 gay elders in community and long-term care settings. Participants reported fear of being rejected or neglected by healthcare providers, particularly personal care aides; fear of not being accepted and respected by other residents; fear of having to go back into the closet if placed in long-term care; and a preference for gay-friendly care. Participants suggested staff training to promote acceptance and respect for gay people, and favorably perceived gay-specific and gay-friendly living arrangements.     

Recruitment and Retention in a Parenting Intervention: A Case Study with Parents Aging Out of the Child Welfare System

ABSTRACT

Parenting interventions are efficacious in reducing child maltreatment and negative child behaviors, yet the recruitment and retention of parents, especially vulnerable parents, in such interventions can be challenging. Prior research identifies several ways to improve recruitment and retention including laying the foundation for the intervention, fostering relationships with parents, ensuring fit of the intervention with the intended population, and identifying barriers to parents’ participation. This case study presents a process of recruiting and retaining a vulnerable group of parents, specifically parenting youth aging out of the child welfare system. In addition to outlining the strategies used, lessons learned are highlighted. Parents expressed interest in the parenting intervention, experienced significant needs, negotiated great instability in their lives, and valued the social connections facilitated by the group intervention. Despite the research team following best practices and investing significant time and resources, recruitment and retention remained challenging. Implications for future work in this area are presented.     

从日常生活言谈及科学理论言谈看同一性的本体论问题

文章介绍了分析哲学中关于同一性的本体论问题的一些解答,特别解释了奎因是怎样从日常生活言谈及科学理论言谈的角度出发得出一种相对同一性的观点的。奎因的工作展示了像同一性这样相对抽象的哲学理论概念如何能够在具体的日常生活及科学实践的语境中得到澄清。在讨论了奎因的非实在论方法在分析的形而上学中的广泛应用之后,作者介绍了麦克道尔对道德投射主义的批判,然后论证麦克道尔的工作可以被用来挑战上述的非实在主义的形而上学理论。     

积极老龄化理念下的老年教育课程建设策略

发展老年教育是实施积极老龄化战略的重要举措,课程建设是教育目标得以实现的基本保证.结合当前老年教育课程建设的不足,本文提出,老年教育课程建设应以健康、参与和保障三大支柱作为服务目标,着力从课程目标取向、课程内容建构、课程实施形式以及课程师资组成等方面回应和落实积极老龄化理念的要求.