Prevalence of Elder Mistreatment as Reported by Social Workers in a Probability Sample of Adult Day Health Care Clients

ABSTRACT

There are growing numbers of Adult Day Health Care (ADHC) programs providing needed health services to community-dwelling elderly. Therefore, ADHC staff are in an opportune position to identify and to intervene in suspected elder mistreatment (EM) cases. In this paper, prevalence estimates of EM are reported for a probability sample of ADHC clients in New York State, using data provided during a social worker informant interview. The abuse “signs and symptoms” items in the social worker informant interview schedule were divided into two categories: (1) physical indicators and (2) client's behavioral indicators. Physical indicators included unexplained bruises and welts, unexplained burns, unexplained lacerations or abrasions, human bite marks, and frequent injuries that are “accidental” or “unexplained.” Client's behavioral indicators included apprehension, being frightened, and afraid to go home. EM prevalence for all 8 items was 12.3 percent. When “apprehensive” was excluded, the EM prevalence was 3.6 percent in this sample. These findings suggest that ADHC provides a point of contact for the assessment and intervention of EM that might otherwise be overlooked among elders who are often isolated or homebound.     

Shame in the Clinical Process with LGBTQ Clients

This commentary integrates the literature on the social and psychological dynamics of shame and discusses its relevance to the clinical process, especially with lesbian, gay, bisexual, and transgender and queer clients. It is argued that engagements with shame, especially where sexual desire, sexual orientation, or gender identity is a foremost consideration or conflict, may be the most important factor in producing and maintaining the therapeutic alliance. Shame, a social emotion, is considered in the light of work done in sociology, psychology, neuroscience, and psychoanalysis. Future directions for clinical research are suggested.     

Issues in Psychotherapy with Clients Affiliated with the Opposing Side in a Violent Political Conflict

The therapeutic dyad of clinician and client affiliated with rival groups in a violent conflict shares many features that complicate psychotherapy with persons of different ethnic, racial, and cultural groups, including lack of knowledge, negative stereotyping, differences in fundamental values and world views, and power differentials. Although a great deal has been written about these matters, very little has been written about the therapeutic dynamic where therapist and client are affiliated with different sides of a violent political conflict. Based on the sparse literature on the subject and on the clinical experiences of the author and her colleagues, this paper discusses three features that characterize this dynamic, which do not appear in the same way in therapy involving dyads of different races, ethnic groups, or cultures. These are the presence of the “enemy” in the consulting room, the therapist’s feelings of mistrust towards the client as a representative of the opposing group, and the client’s feelings of guilt towards the therapist as a representative of the injured group. The impacts of each feature on the therapist, client, and the therapeutic encounter are explored and suggestions are made for dealing with them. The hope is that professionals’ awareness of these issues will help improve the quality of psychotherapy with persons on the rival side of a violent political conflict.     

Relational Quandaries in the Treatment of Forensic Clients

This article examines the sources of relational difficulties inherent in clinical work with forensic clients. Left alone, common countertransference feelings, responses, and defense mechanisms can disrupt and ultimately derail treatment. Concepts relating to the management of countertransference offer a path with which to integrate therapists’ affective reactions as a mechanism of therapy. A relational framework utilizing the affective dynamics between client and therapist to develop and promote treatment goals is introduced and the process of formulating it is described. Practice examples are offered.     

Trauma and the Clinician: Therapeutic Implications in Clinical Work with Clients

This article explores clinical issues related to self-disclosure to clients following a traumatic event in clinicians' lives. In particular, special attention is paid to the role of self-disclosure in clinical work when clinicians are conflicted about whether or not to share personal information or how to communicate it to clients due to the nature of the trauma. Therapeutic implications, both short and long term, associated with such self-disclosure are discussed.     

Psychodynamic Work With Clients in the Latter end of Life

Abstract

Mannie Sher is the Principal Social Worker at the Paddington Centre for Psychotherapy, London, where his responsibilities include a combination of team management, clinical work, teaching and consultation. In 1964 he graduated as a Social Worker at the University of Wit-watersrand, South Africa, and after several years experience in the Family Welfare and Child Guidance fields, completed the training in Adult Psychotherapy at the Tavistock Clinic (1976). He is a member of the British Association of Psychotherapists.     

Factors Affecting the Probability of Choosing a Risky Diet

Eating a poor diet is risky behavior. Inadequate nutrition compromises health and can increase the probability of premature death and/or reduced life quality. This paper uses a cost-benefit analysis from a health economic perspective to assess impact of costs and benefits associated with the odds of choosing a risky diet. Results indicate that time preference as measured through education, smoking, exercise, nutrition panel use, and motivation for nutrition knowledge significantly affect the odds of choosing a risky diet. In addition, variables hypothesized to influence the associated costs of tradeoff between present and future utility—location (both region and urbanization), income, race, gender, and age—are found to have an impact on the likelihood of choosing a risky diet.     

A Case Against Making the Control of Clients a Negotiable Contingency for Interdisciplinary Teams

Most discussions of interdisciplinary teamsassume that cross-functional teams are desirable.Critical analyses of the fundamental contradictionsinherent in bringing together professionals with diverse ideologies, interests, contingencies, andtechnologies are rare. Even less common are discussionsof the negative consequences of these contradictions forclients. Based on observations in an institution for youth-in-trouble, this paper argues thatthe control of clients is one key process underlyingconflicts and dilemmas in interdisciplinary teams; itbuilds a case against making the control of clients a negotiable contingency for teams. Given theuniversal nature of control mechanisms, those mostdirectly responsible for control have a superiorbargaining position because, in order to be effective,their control routines must be consistent. Althoughthese workers may yield to other treatment ideologiesregarding particular clients, the overall outcome is theenhancement of their interests. Moreover, the outcome of negotiations may generate confusionfor clients because of inconsistencies in theapplication of control mechanisms. Three strategies tominimize interprofessional negotiations regarding the control of clients are discussed: theformulation of clear boundaries between thoseresponsible for control and those who are not; theestablishment of policies to address conflicts betweencontrol and competing treatments; and, client determinationof differential levels of interprofessional coordinationand cooperation.     

Exploring the Design of Financial Counseling for Mortgage Borrowers in Default

This paper analyzes the effects of counseling provided to borrowers in mortgage default (n = 299). Borrowers receiving more hours of counseling perceive counseling more favorably than those receiving fewer hours of counseling. Using measures of marketing efforts to instrument counseling time confirms the positive effect of counseling duration on borrower ratings of counseling. Borrowers are more likely to attend additional counseling sessions after receiving face-to-face counseling as opposed to telephone counseling, although preference among modes can largely be explained by time in counseling. Each additional hour of counseling reduces the marginal probability of a borrower moving to a more severe stage of foreclosure. Counseling could be more successful if provided for longer durations regardless of the delivery mode.

Portfolio assessment in a collaborative program evaluation: the reliability and validity of a family literacy portfolio

Evaluations increasingly use open-ended assessments, such as portfolios, to gather information about program impact. Portfolios, however, present challenges in achieving acceptable levels of reliability and often lack evidence to support validity. This article describes the components of a portfolio assessment system developed in a collaborative evaluation of a family literacy program. Staff of a family literacy program and two evaluators collaborated to develop the assessment and the tools that frame the review of the portfolios. Rubrics, exemplar portfolios, portfolio logs, and lists of ‘look-fors’ were developed to guide raters in the scoring and to improve the reliability of scores and validity of decisions about the program. Inter-rater reliability for the portfolio assessment was 0.79 for holistic scores and 0.74 for analytic scores. With respect to validity, holistic and analytic scores correlated with criterion measures from 0.50 to 0.59, providing initial evidence of a common construct.     

Career Counseling With Lesbian Clients: Using the Theory of Work Adjustment as a Framework

Using the Theory of Work Adjustment (TWA; R. V. Dawis & L. H. Lofquist, 1984; L. H. Lofquist & R. V. Dawis, 1969) as a framework for identifying potential career challenges for lesbians, the authors explore the relationship between outness and discrimination and the four primary components of TWA. Career counseling implications are discussed, and specific suggestions are made for counselors.     

Giving Clients a Backstage Experience: A Case of Dramaturgical Trouble in the Professional Performance of Drug Treatment

Professionals who provide drug treatment to young people seek to approach clients as agents of change, i.e., highlight clients' agency and ownership of treatment plans. On the basis of ethnographic data from two treatment institutions in Denmark, this article investigates how everyday interaction organizes clients' experiences in ways that alternately support and contradict this professional ambition. Notably, findings indicate that talk and material arrangements “backstage” make professionals, not clients, appear as the real agents of change. Clients are increasingly encouraged to participate in meetings “backstage,” where treatment is organized, but, contrary to intentions, clients may experience participation as debasing rather than empowering.     

The Role of the Economic Sector in the Provision of Care to Trusting Clients

With implications for senior care as well as child care, this article compares for‐profit and nonprofit dependent‐care facilities in areas of service that are not readily visible to consumers. Findings gleaned from the child‐care industry indicate that nonprofit facilities provide a higher quality of service on professionally identified variables than do their for‐profit counterparts. For‐profit directors were more likely to implement cost efficiencies that were not immediately apparent to clients. Despite this, significantly more of the for‐profits were displeased with their financial situation than were their nonprofit counterparts. The study suggests that professional background and training of directors exercises an influence on management satisfaction and decisions, independent of sector.     

Estimating sex discrimination in professional occupations with the dictionary of occupational titles

Although women have gained entrance into some of the top professional occupations, they appear to have achieved few economic gains from this progress. The extensive occupational segregation existing between men and women in all occupations handicaps investigations of the sources of this persistent inequality. This article proposes an exploratory method for identifying occupations containing comparable work and presents an analysis of male‐female wage differences within a subset of the highly skilled professional occupations. Using a cluster analysis of the characteristics of jobs available in the 1977 Dictionary of Occupational Titles, three clusters of high‐skill occupations are identified. Next, a sample of labor‐force participants, aged 25 to 35 years and employed in these occupations, is used in an ordinary least squares (OLS) regression of hourly wages on a standard set of labor market traits. These results are used to decompose the male‐female wage gap. A liberal interpretation of the decomposition estimates is that between 39.9% and 58.8% of the gap is attributed to comparable‐worth discrimination.     

Estimating the effects of network covariates on subgroup insularity with a hierarchical mixed membership stochastic blockmodel

Social networks describe the relationships and interactions among a group of individuals. In many peer relationships, individuals tend to associate more often with some members than others, forming subgroups or clusters. Subgroup structure varies across networks; subgroups may be insular, appearing distinct and isolated from one another, or subgroups may be so integrated that subgroup structure is not visually apparent, and there are numerous ways of quantifying these types of structures. We propose a new model that relates the amount of subgroup integration to network attributes, building on the mixed membership stochastic blockmodel (Airoldi et al., 2008) and subsequent work by Sweet and Zheng (2017) and Sweet et al. (2014). We explore some of the operating characteristics of this model with simulated data and apply this model to determine the relationship between teachers’ instructional practices and their classrooms’ peer network subgroup structure.     

Social Workers' Use of the Internet and E-Mail to Help Clients in Virginia

A survey of a random sample of licensed social workers in Virginia showed 98.8% had Internet access in either their home or workplace. A comparison of this study with a study conducted in the early 2000s indicated more than 20% difference regarding e-mail communication with clients and Internet use for work-related research. Social workers who actually used the Internet and e-mail tended to expect a future increase in their use, in contrast with nonusers. Stepwise multiple logistic regression analyses found age and type of agency (private/for-profit) as factors negatively related to having Internet access in the workplace, age, and the reason “E-mail is not secure enough” as factors negatively related in the future e-mail communication with clients among current nonusers.     

A Re-Conceptualization of the Working Alliance in Cross-Cultural Practice with Non-Western Clients: Integrating Relational Perspectives and Multicultural Theories

This article will addresses a gap in the literature regarding the working alliance in cross-cultural treatment. The paper draws on references from current relational theories and multicultural conceptual and empirical sources to re-conceptualize the definition of the working alliance to include cross-cultural dynamics between Asian clients and European-American therapists as a case in point. The paper includes an overview of the working alliance, and a proposal for the inclusion of specific relational domains that this author has found to be important for the definition of the working alliance. These domains are empathy, mutuality, the dynamics of power and authority, the use of self, and the process of communication. A case vignette is included to illustrate these discrete domains. The paper opens new directions for clinical practice and research in the area of the working alliance in cross-cultural counseling.     

Women Working in a Greedy Institution: Commitment and Emotional Labour in the Union Movement

This paper seeks to move beyond the restrictions of limited representations of women's participation in the union movement. Through a focus on the union movement as a ‘greedy institution’, it is argued that women's union involvement requires complex and dynamic negotiations with its gendered discourses and practices. As a greedy institution, the union movement demands considerable depth of commitment and loyalty, as well as high levels of work and emotional labour. Based on a study of a network of women union officials, this paper discusses the ways women interpret three main aspects of trade union work: commitment, workload and emotional labour. I argue that the strategies the women officials employ do not remain static within a limited frame of gender difference from men. Rather, they must engage with the effects of male dominance of the union movement as well as the difficulties associated with union activism, family, service to members, leadership, and care in order to take up the political opportunities available in this greedy institution.