Creating elder-friendly communities: preparations for an aging society

Because many communities where older people live were not designed for their needs, older residents may require support to remain in the least restrictive environment. "Age-prepared communities" utilize community planning and advocacy to foster aging in place. "Elder-friendly communities" are places that actively involve, value, and support older adults, both active and frail, with infrastructure and services that effectively accommodate their changing needs. This paper presents an analysis of the literature and results of a Delphi study identifying the most important characteristics of an elder-friendly community: accessible and affordable transportation, housing, health care, safety, and community involvement opportunities. We also highlight innovative programs and identify how social workers can be instrumental in developing elder-friendly communities.     

Chapter 17. Rural Mental Health

SUMMARY

Mental health services available in many rural communities are too limited in scope and availability to meet the needs of rural citizens. The future of mental health services for the rural poor will be impacted by state government decisions about Medicaid funding priorities. It is important that rural practitioners, especially those that work in the fields of mental health, health, and aging services, engage in advocacy for better coverage of the rural poor and low-income elderly persons. This chapter discusses issues of advocacy related to improving the provision of mental health services to older rural citizens as an important goal in the larger effort to expand and improve rural mental health service delivery throughout the nation.     

Links between social environment and health care utilization and costs

The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.     

A Collaboratively Designed Child Mental Health Service Model: Multiple Family Groups for Urban Children with Conduct Difficulties

This paper presents preliminary outcomes associated with an experimental, longitudinal study of a Multiple Family Group (MFG) service delivery approach set within thirteen urban outpatient clinics serving children and their families living in inner-city, primarily African American and Latino communities. Specifically, this paper focuses on parent reports of child oppositional behavior and parenting stress over time. MFG is a flexible, protocol-driven approach designed to address the most common reason for referral to outpatient child mental health clinics, childhood behavioral difficulties. The MFG also aims to enhance family-level engagement and retention in ongoing care. Further, the service delivery model was collaboratively developed with intensive input from parents rearing children with conduct difficulties, parent advocates, community-based child mental health providers and services research staff in order to ultimately expand the number of effective service models that can be situated within "real world," urban child mental health settings.     

Service integration: something old and something new

The authors trace the definition and challenges of "service integration," variously known over time as "collaboration," "coordination," "human services integration," and "one-stop shopping." While the common use of service integration terminology currently may seem to indicate a consensus in favor of a broad systemic reform, motivations and expectations for service integration differ significantly among different players in the service system. The authors conclude that service integration cannot be defined by a particular service model or outcome, but instead should be conceived of as an ongoing reform process. This process, when well-designed and implemented with long-term vision, can reduce duplication, strengthen communities, and improve client outcomes.     

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.     

Overcoming Barriers to Serving the Aging/Mental Health Client

This paper presents a model, based upon a series of state-level initiatives in the Commonwealth of Pennsylvania, for improving coordination between the aging and mental health systems to better serve elderly persons with mental health problems. The mental health needs of the elderly are discussed and service delivery obstacles - systemic, individual, and agency/staff - are reviewed and synthesized. Policy initiatives by the Commonwealth of Pennsylvania that relate to these issues are presented as a case study, with a focus upon a series of regional conferences held around the state for providers in the aging and mental health networks to encourage better coordination of services. The process and outcomes of these conferences are discussed, together with an analysis of the implications for practice, policy, and teaching.     

从“疾病治疗”到“健康维持”——老龄化社会健康服务模式的整体转型

老龄化对任何国家的医疗体系都是巨大的挑战,进入老龄化的发达国家无不把"控制医疗费用"作为卫生改革的核心。从国际经验,尤其是日本的经验看,影响健康服务体系和整个社会的可持续发展的并不是老龄化本身,而是采取了何种应对措施。日本的经验说明,尽管成本控制和改善服务两个目标之间经常存在冲突,但是对预防保健和长期照护服务的投入可以有效减少对昂贵且不适用的住院服务的利用,在更好地满足了社会成员健康需求的同时,反而使卫生费用获得了一定程度的控制。这对我国的启示是,一方面要将预防保健提高到战略位置进行重新规划,另一方面要尽快构建起全国性的长期照护制度框架。     

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.     

Hoarding Cases Involving Older Adults: The Transition From a Private Matter to the Public Sector

Hoarding interventions with older adults require significant resources from multiple public agencies, yet recidivism occurs frequently. To improve services through better coordination, some communities have formed multiagency hoarding teams (MAHT), which include aging services. MAHTs requested this mixed methods study to understand the progression of cases through the public sector. Quantitative data collected on 52 cases involving adults ages 60+ identified steps in this process. Qualitative data collected from MAHT members were the basis for case studies illustrating the progression of cases through the public sector. Findings have implications for social workers involved in local service coordination, training, and policy.     

Consultation,for a Change? Engaging Users and Communities in the Policy Process

The process of consultation has become integral to the development, implementation and evaluation of a raft of UK health and social policies. However, the current bewildering patchwork of area–based initiatives means that, in many localities, it is impossible to evaluate the outcomes of particular targeted initiatives, let alone make sense of local planning consultations, Best Value reviews and (multi–agency) service reviews which run concurrently. The cumulative effects of this consultation "overload" threaten to swamp both local authorities and their service users. Consul–tation is itself a crucial yet deeply problematic process. There is an official view which holds that an "old" model of consultation—often tokenistic and unrepresentative—is being replaced with a "new" one. This paper examines and challenges that view in relation to the key policy areas of housing, social services and policing. It also pays particular attention to, and problematizes, the notion of "hard–to–reach groups", which is so dominant in the discourse of consultation. The paper argues that developing appropriate tools and recognizing that consultation is a process—not an event—are essential starting points in addressing these problems. The next step is to reconcile the principles of both evidence–based policy and user–led services into a strategic (and "joined–up") framework. But, when all this is accomplished, we still need to question the political and fiscal contexts in which policy–making takes place and within which the process of consultation is itself bounded.     

First Nations parenting and child reunification: Identifying strengths,barriers, and community needs within the child welfare system

First Nations communities are seeking to improve current service delivery models and create alternative evidence‐based strategies. A First Nations child welfare organization has prioritized further understanding of reunification and parenting, including identification of successes and barriers to reunification, and service needs within communities. These priorities were addressed with a community‐based participatory research model and guided by a Research Advisory. Results were analysed using a blend of grounded theory and thematic analysis techniques. Participants indicated that placing children with extended family or within home communities facilitate best child outcomes. These reunifications could be increased by promoting parental and community capacity. Successes identified within communities included available supports, such as those that increased empowerment and community capacity. Identified barriers within communities were the lack of culturally appropriate services, hesitancy to obtain available support due to fears of child welfare intervention, and mental health difficulties of community member.     

Hoarding cases involving older adults: the transition from a private matter to the public sector

Hoarding interventions with older adults require significant resources from multiple public agencies, yet recidivism occurs frequently. To improve services through better coordination, some communities have formed multiagency hoarding teams (MAHT), which include aging services. MAHTs requested this mixed methods study to understand the progression of cases through the public sector. Quantitative data collected on 52 cases involving adults ages 60+ identified steps in this process. Qualitative data collected from MAHT members were the basis for case studies illustrating the progression of cases through the public sector. Findings have implications for social workers involved in local service coordination, training, and policy.     

Conceptual and Methodological Linkages in Cross–Cultural Groups and Cross–National Aging Research

The international growth and the expected size of older populations require effective research strategies in life–course development and aging research across the globe. New conceptual frameworks and empirical research approaches are needed that are sensitive to similarities and differences in aging related processes across national, ethnic, and cultural group boundaries. These models and research approaches should contribute to distinguishing "aging–in–place–of–origin" from "aging–out–of–place–of–origin," and the influences of such factors as nationality, culturally affected behaviors, acculturation and intra–familial processes, on intra– and cross–country comparisons of aging related phenomena. Brief examples of how these new frameworks can be applied in addressing both theoretical and practical service issues are drawn from the aging research foci of the articles in this issue.     

An Ecological View of Aging

A transactional view of aging highlights the need for attachments throughout the life course. It emphasizes the environment, its supports, its nutritive and non-nutritive or noxious qualities as critical to our understanding of the aging process. This article discusses the aging process from an ecological perspective. It includes an exploration of theoretical developments and service delivery needs. It also provides a case example of a homeless 75-year-old woman to illustrate the dehumanizing gaps in our service delivery systems that make the consolidation of sense of ego integrity an unlikely outcome.     

Increasing aging and advocacy competency: the intergenerational advocacy pilot project

The Council on Social Work Education's (CSWE) Strengthening Aging and Gerontology Education for Social Work (SAGE-SW) project, funded by the John A. Hartford Foundation partnered with the National Committee to Preserve Social Security and Medicare (NCPSSM) to develop an Intergenerational Policy and Advocacy Project (IAP). This curriculum pilot project, based on a community organization model, was conducted with 13 baccalaureate social work (BSW) and master's social work (MSW) programs across the country and 122 students. The project was one method to pursue CSWE SAGE-SW's efforts to infuse aging content into social work foundation curricula, to support intergenerational teaching, to strengthen social work advocacy skills, and to provide social work students with positive experiences working with older adults. Pilot sites were asked to carry out the project as part of an existing course foundation or field practicum course. Project activities included collaboration with a variety of community agencies, holding issues or "town hall" forums in order to educate community members about critical policy issues affecting older adults; making contacts and establishing relationships with local, state and/or federal legislators; and conducting assessments of the service needs of older adults in the students' communities. Questionnaires, feedback, pre-post evaluations as well as brief accounts of each project are presented. Participants considered the IAP to be a successful project in terms of the objectives of increasing awareness and competency among social work students of aging issues and of promoting intergenerational linkages between older people and social work students.     

Exploring the Health Needs of Aging LGBT Adults in the Cape Fear Region of North Carolina

ABSTRACT

This study explored issues of culturally sensitive healthcare practice and needs among lesbian, gay, bisexual and transgender aging adults in coastal North Carolina. Survey data results indicated the largest problem was a history of verbally harassment and need for culturally sensitive healthcare. In conclusion, culturally sensitive interventions are needed to address the health disparities and unique needs of LGBT aging adults. Cultural sensitivity training for service providers is suggested as a vital step in addressing health disparities of aging LGBT adults. Implications for research include further exploration of health related needs of these often hidden and underserved population groups.     

Importance of Land,family and culture for a good life: Remote Aboriginal people with disability and carers

Worldwide health and social outcomes of Indigenous people are poorer than those of non-Indigenous. In Australia, the Indigenous population experience disability at more than twice the rate of the non-Indigenous population, and a quarter live in geographically remote areas. The challenges associated with accessing services and supports in remote communities can impact on a good life for Aboriginal people with disability. Interviews were conducted with Aboriginal people (An angu) with disability and family carers from remote Central Australian communities and service workers. Thematic data analysis determined factors An angu viewed as essential to living a good life: connection to their Lands, being with family and engaging in cultural activities. Workers' support for a good life involves “Proper Way” help and an understanding of An angu culture. Three culturally relevant strengths-based concepts are important in supporting An angu with disability to live a good life: being connected to the Lands and family, sharing together and working together.     

过渡治理情境下的中国社会服务困境:基于Z市社会工作服务的研究

社会工作近十年来在创新社会治理的推动下发展迅速。本文将重点关注于社会服务组织的服务供给过程及其导致的社会服务困境。通过对治理情境的拓展分析,引入过渡治理情境概念,分析我国社会服务供给。在此情境下,本文以Z市家庭综合服务中心为例,围绕自由裁量权这一概念讨论社会服务组织的服务供给策略及其所导致的服务困境。在过渡治理情境中,消极的自由裁量权与社会工作的半专业化发展结合在一起,社会服务组织选择了“活动化”和“指标化”的服务供给,令社会服务处于创新和碎片化之间,而导致社会服务陷入困境。社会服务困境根源的解决在于建立合作的治理情境、强化本土化社工专业力量以及充分发挥第三方的社会服务供给效力。     

Visiting the mentally ill: volunteer visitors at Saskatchewan hospital, Weyburn 1950-1965

This article offers a glimpse into the lives and activities of some of the patients, volunteers and staff in the Saskatchewan mental health system during the period of deinstitutionalization. Drawing on her own experience as a patient in psychiatric wards as well as ongoing research in the history of mental health, it features the role of Regina Volunteer Visitors in Saskatchewan Hospital, Weyburn and examines the importance of occupational and recreational therapies and activities in improving the lives of the patients in that institution. It emphasizes the perspectives of patients and volunteers who actively worked to develop recreational activities, with the intention of helping individuals connect with the surrounding communities. The views and perspectives presented here are drawn from a variety of historical and oral interview sources, including views from visitors to the asylum and patients who lived within its walls. The author has also been a consumer of mental health services, and spent time in the Provincial Mental Hospital in North Battleford. The article therefore makes an important contribution to enhancing our understanding of the social history of deinstitutionalization, not only for its unique source base, but also because those sources have been examined and explained to readers through the perspectives of a former patient herself. This article draws significant attention to the changing opportunities for patients as they interacted with the women's volunteer groups, as well as to how the changes brought about by the encroaching deinstitutionalization, care in the community, and decisions from "above" affected the individuals on the ground.