Practical considerations for maintaining independence among individuals with functional impairment

Social workers, gerontologists, and related health professionals must learn to recognize how aging, disability, and chronic illness affects individuals and their families' physical, psychological, and social functioning in order to develop effective interventions for their clients. This article discusses prevention strategies to help facilitate functional consequences of aging, including chronic illness and disease and offers suggestions for assisting clients to cope and manage the consequences of illness in frail elder adults.     

ADULT DAY CARE CLIENTS

Discriminant function analyses were used to examine the daily functioning levels of three populations of elderly: Senior citizen center participants, adult day care clients and nursing home patients. The analyses revealed that the adult day care program was serving a distinct population of elderly who have unique needs. The Level of Care Rating Scale, developed to assess functioning and used to distinguish among populations, is also a valid means of identifying and monitoring high risk individuals in the two more independent populations. Further research in the form of a controlled study is recommended to ascertain the overall impact of adult day care in delaying or preventing institutionalization.     

Group Work with First Episode Schizophrenia Clients

ABSTRACT

Group work with first episode schizophrenia clients is an effective way of improving ego functioning, building adaptive coping skills, and addressing the painful feelings associated with learning of this diagnosis. First episode schizophrenia clients are typically in their late teens to late twenties, and confront the cognitive disability, the stigma and the loss of social roles and statuses at a developmentally difficult stage of emotional growth. The dynamic processes by which cohesive groups reduce isolation, build self-esteem, and provide peer support are illustrated with case material. The group work consists of integrating psychoeducation with clients' concerns in order to provide optimal adjustment to the disease. The groups described in this article are structured within a continuing care team treatment model in a medical facility, but the group work discussed may be utilized in a variety of settings.     

A Preliminary Study of Medical Services for Persons with Alzheimer's Disease

Logistic regression is used to examine medical ser- vice recommendations by staff in California's diagnostic and treat- ment centers to a clinical, non-random sample of Alzheimer's dis- ease clients (N . = 822). Dependent variables include physician consultation, medical clinic, medication management, and psychiat- ric services. Predictor variables include patients' enabling, need, predisposing characteristics, family consideralions. and organization affiliation. Significant predictors include previous service use, pa- tient functioning, family characteristics, and the specific center rec- ommending h e service.     

Addressing risk factors of cognitive impairment in adults aging with HIV: a social work model

With advances in life-extending medications and later- life infections, the number of older adults with HIV is increasing. Unfortunately, the synergistic effects of aging with HIV may place many people at risk of developing cognitive impairments which can disrupt everyday functioning. Fortunately, cognitive reserve may be maintained, or in some cases improved, by taking action to prevent or mitigate such loss. Preventative and treatment strategies that support biopsychosocial aspects of cognition include reducing alcohol and substance use; improving nutrition; diminishing the effects of comorbidities; increasing social contact; reducing depression and stress levels; engaging in cognitively stimulating activities; applying cognitive remediation therapies; and incorporating psychopharmacological interventions. Such strategies can improve the physiological integrity and health of the brain, thus supporting neuroplasticity and increasing cognitive reserve. Social workers are in a favorable position to recognize cognitive decline in clients and recommend or administer solutions to address such problems. A model for social workers advocating for older clients with HIV who have cognitive problems is provided.     

Behavioral Social Work with Obsessive-Compulsive Disorder

The symptomatology of obsessive-compulsive disorder is described and its negative impact on daily functioning is noted. The outcome of the application of various forms of behavioral treatment, including systematic desensitization, imaginal exposure, aversion treatment and thought-stopping is discussed with reference to theoretical formulations of the function of obsessions and compulsions vis-ô-vis anxiety. Behavioral treatment via a combination of exposure to feared situations and response prevention or blocking of ritualistic behavior has proven to be the treatment of choice for this disorder. It is described here in some detail and suggestions regarding clinical issues in conducting this treatment are given. Factors identified as possible predictors of outcome include depression, anxious mood state, patients' beliefs in the probability of feared consequences, social functioning, motivation level and therapist characteristics. It is concluded that exposure and response prevention has substantially improved the prognosis of clients with obsessive-compulsive disorder but that programs aimed at maintenance of gains over time are needed.     

Examining Protective Factors for Dysthymia Among Individuals Attending Substance Abuse Treatment

ABSTRACT

Dysthymia affects millions of people and has been associated with impaired psychosocial and occupational functioning and poor clinical treatment outcomes. Yet few studies have examined protective factors that can be utilized to help individuals with dysthymia in clinical settings, particularly among individuals with comorbid substance use disorders. The purpose of this study was to examine the potential protective quality of adult attachment dimensions, spirituality, and meaning in life among clients with and without dysthymia in treatment for addiction. Data were obtained from 305 self-report questionnaires administered to clients attending a residential substance abuse treatment center. Approximately 25% of the sample met criteria for dysthymia. Results from logistic regression analyses indicated that purpose and meaning in life and attachment anxiety were the most important protective factors against having dysthymia. These results suggest that mental health professionals may need to integrate these protective factors into the treatment of individuals with dysthymia and substance use disorders, which may enhance treatment outcomes and maximize treatment effectiveness. Future studies should continue to explore protective factors that can assist individuals who experience these comorbid conditions and consider replicating this study using an ethnically diverse sample and other clinical settings to determine the generalizability of the findings.     

An inquiry into the significance of nail‐biting 1

Substance abuse is connected to considerable suffering and symptoms. Neuropsychological assessment supports understanding of the distress and the symptoms of the individual client and therefore is increasingly requested in substance abuse treatment. Substances, however, influence neuropsychological functions and emotional states. Therefore, assessment often needs to be postponed. Conducted at a suitable point of time, with respect to abstinence and treatment planning, assessment might provide understanding of the needs and possibilities of the client. This work contributes with suggestions on how neuropsychological assessment might be conducted in substance abuse treatment. Because the effects of substances are considerable, an overview of the effects of varying substances on neuropsychological functioning is presented. It is also suggested that assessment should be understood as a collaborative process that should support clients’ understanding of themselves.     

Monitoring Interventions with Young Israeli Families

Correspondence to Dr Rami Benbenishty, School of Social Work, Hebrew University, Jerusalem, Israel 91905. Summary This paper describes a study monitoring interventions with familiestreated by a welfare agency in Jerusalem, Israel. The treatmentapproach is eclectic and is based mainly on a view of the familyas a system and on task-centred and problem solving orientationsto family treatment. Sixty families were studied. The clients'median age was about 30 years old and the median number of childrenwas two per family. The clients approached the welfare agencyfor four main reasons: financial difficulties (especially heavydebts), severe health problems and disabilities, marital difficulties,and problems in raising children. The practitioners identifiedin two thirds of the families dangerous situations that neededimmediate attention. A repeated measures design utilizing several outcome measureswas used. According to the workers' assessments, based on theCRS (Epstein et al., 1982), functioning improved and progresstoward goal attainment was observed in most families. The magnitudeof changes in functioning, however, was small. The workers'and clients' assessments of change and of goal attainment weremore positive. There were indications of deterioration at followup. The treatment outcomes are discussed in light of the clientand treatment characteristics. Changes in client selection,length of treatment, and an active follow up strategy are suggested.     

ANALYSIS OF CLIENT CAREERS FOR PROGRAM EVALUATION

The present study analyzes the careers of clients, both within and between agencies. Several phases of the careers of 316 adolescent clients are examined as part of a process evaluation of Professional Youth Services (PYS). Clients' movement within PYS is described to provide on understanding of when and why clients leave a helping agency and to describe some of the characteristics of clients who are most likely to have their treatment interrupted. In addition, clients' "between agency" movement is analyzed by exploring the other human service agency involvements) of clients; in this way the role of PYS in the larger service delivery network is clarified.     

How Social Workers Demonstrate Respect for Elderly Clients

Although respect is a crucial aspect of social work practice, few studies have examined how social workers convey their respect for elderly clients. This study explored the various forms of respect demonstrated by social workers when they were with older clients. Fifty social workers serving elderly clients were surveyed by a questionnaire with closed- and open-ended questions. Based on data on ways the social workers respected their elderly clients, the study identified 7 forms most frequently practiced and considered most important. They are linguistic respect, care respect, acquiescent respect, salutatory respect, presentational respect, spatial respect, and consultative respect. The key expressions of these forms are introduced in quantitative data and a narrative form. These findings provide insight as to how social workers exhibit respect for elderly clients in their practice. The results of this exploration may be useful in developing a more comprehensive typology of the forms signifying respect for elderly clients.     

Impact of Social Work Practice in Public Defense

Public defenders are increasingly welcoming social workers into their practice, but there is little understanding of the impact of social work services in this context. This study used propensity score matching to determine the effect of social work services on public defense clients in terms of the number and severity of criminal charges when statistically controlling for pre-existing criminal history and demographic characteristics. Findings indicate that social work and non-social work clients were similar in terms of demographics and that clients in both groups were more likely to have incurred misdemeanor charges, but clients in the social work group experienced more, suggesting greater life disruption. When comparing clients who did and did not receive social work services, results indicate that the number of misdemeanor charges incurred during a two-year time period was lower for clients who received social work services. Implications for practice and future research are discussed.     

Evaluating the Roles of Professional Geriatric Care Managers in Maintaining the Quality of Life for Older Americans

This study examined the roles of Professional Geriatric Care Managers (PGCMs). In-depth telephone surveys were completed with 19 PGCMs. Qualitative data were coded independently by two researchers. PGCMs reported that most clients and/or families seek services in response to a health crisis or because a family member was providing care at a distance. Most emphasized the importance of treating clients as autonomous decision-makers. Services described as most useful were supporting families and caregivers, being an advocate for clients, conducting initial assessments and ongoing follow up, and educating families about community resources and the financing of long term care. Regarding maintaining the quality of life for their older clients, a number of care managers described assisting clients to live independently at home, arranging for transfer to an appropriate level of care, and helping clients die peacefully with dignity. Major challenges PGCMs encountered were family conflicts and obtaining needed services. Recommendations to improve PGCM practice include increasing awareness of services, and establishing minimum professional standards through certification.     

A Cross-Sectional Examination of the Association Between Dyspnea and Distress as Experienced by Palliative Home Care Clients and Their Informal Caregivers

This study examined the association between dyspnea and distress as experienced by both palliative home care clients and their informal caregivers as a unit of care. Cross-sectional analysis was conducted using the interRAI Palliative Care Assessment database. Responses from 6,655 individual palliative home care clients across six regional jurisdictions in Ontario, Canada were included. This study found that clients experiencing dyspnea were more likely to show overall signs of distress; report one or more signs of self-reported distress; and be at risk for depression when compared to clients who do not experience dyspnea. Caregivers of clients experiencing dyspnea were more likely to exhibit distress than caregivers of clients not reporting dyspnea. When indicators of caregiver distress and client distress were combined, 53% of the caregiver-client units exhibited distress. Social work practitioners should include a focus on distress within the care unit as a priority when care planning to meet the needs of persons nearing the end of life. Members of the care team should consider available treatment and management options tailored to meet both the client and their informal caregiver’s needs.     

Use of Single-System Research to Evaluate the Effectiveness of Cognitive-Behavioural Treatment of Schizophrenia

Correspondence to William Bradshaw, Ph.D., LICSW School of Social Work, University of Minnesota, 105 Peters Hall, 1404 Gortner Ave. St. Paul, Minnesota 55108, USA. E-mail: Bbradsha{at}che.umn.edu Summary Practitioner research that utilizes single-system designs andreplication studies has been promoted as a means to developpsychosocial interventions of demonstrated effectiveness. Atthe same time, there has been relatively little practitionerpublication of single-system studies. The purpose of this studywas to evaluate the effectiveness of cognitive-behavioural interventionsin the treatment of schizophrenia. The study used a single-systemmultiple baseline design across seven subjects to evaluate changein clinical outcomes. The AB design included a (A) baselinephase and (B) cognitive-behavioural intervention phase. Standardizedmeasures of psychosocial functioning, severity of symptoms andattainment of treatment goals were used to assess change overthe course of three years treatment. A pre-test/post-test designwas used to measure achievement of treatment goals. All sevenclients made statistically significant improvement in psychosocialfunctioning when the baseline mean was compared to the interventionmean. The average effect size for the seven cases was 2.96.All seven clients made a statistically significant reductionin severity of psychiatric symptoms when the baseline mean wascompared to the intervention mean. The average effect size forthe seven cases was -2.19. All seven clients exceeded the expectedlevel of attainment of treatment goals. The pre-test averagegoal attainment score for the seven cases was 20.65 (sd = .55).The average post-test score was 71 (sd = 8). Directions forfuture research and the applicability of single-system designsfor the practitioner researcher evaluation of mental healthpractice are discussed.     

Theoretical Support and Other Considerations in Using Simulated Clients to Educate Social Workers

This article builds on literature from many helping disciplines supporting the use of simulated clients (sometimes referred to as standardized patients) in training professional students, explaining why the use of simulated clients is more effective in developing clinical skills as compared with student-to-student role-plays. Psychodynamic and Bowen intergenerational family theory, critical to the development of social work knowledge, is used to support the use of simulated clients to portray clients with challenging and complex lives. Risks and benefits of using simulated clients is discussed, along with recommendations to educational programs regarding ways to effectively use this experiential learning method.     

Adaptation and Evaluation of a Group Curriculum for Latino Clients in a Driving Under the Influence Program

The purpose of this study was to describe the process of culturally adapting group curriculum modules for Spanish speaking clients in a Driving Under the Influence Program as well as to test the acceptability of these modules. Using the Group Topics Evaluation Scale (English and Spanish version), 90 clients rated six modules that were presented in 30 different group sessions. Spanish speaking clients were significantly more likely to rate all six modules much higher than their English speaking counterparts, indicating acceptability. This is important as driving-under-the-influence programs may provide access to Latino clients not seen elsewhere. Possible further research is discussed.     

Activation,Public Employment Services and their Clients: The Role of Social Class in a Continental Welfare State

This article fills a gap in the existing literature by investigating how public employment service (PES) staff actually deal with their clients under a continental regime of activation. The results reported here are based on interviews both with PES staff and their unemployed clients in Germany. We argue that due to its Bismarckian origins as an insurance‐based system of ‘unemployment protection’, Germany's system of unemployment compensation is attractive not only for the marginalized, but also for core workers. As a result, PES staff deal with clients from very heterogeneous class backgrounds. We demonstrate that social class is a significant factor in client outcomes, and that earlier research has perhaps overemphasized the role of frontline staff as ‘street‐level bureaucrats’. While staff do have considerable power, the result of the encounters between the administration and clients also depends on the capabilities of the clients, which, in turn, are strongly related to social class.     

Mistrust and Self-Isolation: Barriers to Social Support for Older Adult Methadone Clients

Objectives: The purpose of this study is to explore barriers to the use, maintenance, and expansion of social supports in older adult methadone clients. Methods: The data for this analysis were derived from a qualitative study of the needs of aging methadone clients. Data were collected through face-to-face interviews with 24 methadone clients over the age of 50. Results: A lack of trust was identified as a principal barrier to the use, maintenance, and expansion of the social supports of older adult methadone clients. Causes of this mistrust include issues associated with aging, past traumatic experiences, and difficult personal relationships. Implications: These findings imply that addressing the issue of self isolation and recognizing the reason older adult methadone clients engage in this behavior is a key element in getting this specific population to use, maintain, and foster healthy social supports. A common phrase echoed throughout the interviews is that a person cannot trust anybody. Because of this mistrust, some clients keep to themselves by electing to self-isolate and decline to use, maintain, or foster new relationships. As a result, these individuals are less likely foster and/or engage in healthy social relationships, which are a key component of substance abuse treatment and abstinence maintenance.     

Information technology in social security offices: Changing relations between caseworkers and clients

In this article possible implications of introducing information technology (IT) in social security administrations for their relationship with clients are discussed on the basis of a study on its effects in Netherlands municipal social services departments on clients'bureaucratic competence and caseworkers'discretion the accessibility and susceptibility of the administrations to the influence of clients, and the congruence in the definition of the bureaucratic situation by caseworkers and clients. Results show an increase in hierarchical authority and programming of work processes, a decrease in caseworkers'discretion and information monopoly, a growing discrepancy between caseworkers'and clients'definition of the bureaucratic situation, and an emphasis on verbal communicative aspects in the concrete interaction between the two. It is concluded that IT has paradoxical effects on the relationship between administrations and clients. On one hand the distance between them seems to diminish through an emphasis on direct, physical contacts with street-level officials. On the other, the accessibility and susceptibility of administrations to clients'influence seems to decrease because street-level workers become more embedded in the organization. It becomes more difficult for clients to bring their individual situation to the fore.