The Importance of Adult Guardianship for Social Work Practice

Abstract

Guardianship is a legal intervention used to protect incapacitated adults through the appointment of a surrogate decision maker. Demographic trends and improvements of medical technology suggest that gerontological social workers ought to be particularly concerned about guardianship as more people live into older ages with some degree of impairment. This article presents an overview of the guardianship decision-making process and of the roles social workers can have in promoting social justice through this process.     

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.     

A choice of one's own research advance directives: Anticipatory planning for research subjects with fluctuating or prospective decisionmaking impairments

Mental disorders that may affect decisionmaking capacity, like schizophrenia, have a deleterious effect not only on persons who are afflicted with the disorders but also on their families, their friends, and their communities. Realizing research to develop generalizable knowledge that may benefit this heterogeneous population is crucial. The moral challenge is to fashion processes that both respect research subjects’ autonomy and protect their wellbeing. Research advance directives may provide a mechanism that authorizes potential research subjects to make choices of their own regarding whether they wish to participate in a research protocol, to choose and appoint a surrogate decision maker, and to secure an array of protections for themselves should they lose their decisionmaking capacity during the period of the research protocol. Such research advance directives may be used by persons with fluctuating, limited or prospective decisionmaking impairments.     

A Method for Eliciting Utilities and its Application to Collective Choice

Designing a mechanism that provides a direct incentive for an individual to report her utility function over several alternatives is a difficult task. A framework for such mechanism design is the following: an individual (a decision maker) is faced with an optimization problem (e.g., maximization of expected utility), and a mechanism designer observes the decision maker’s action. The mechanism does reveal the individual’s utility truthfully if the mechanism designer, having observed the decision maker’s action, infers the decision maker’s utilities over several alternatives. This paper studies an example of such a mechanism and discusses its application to the problem of optimal social choice. Under certain simplifying assumptions about individuals’ utility functions and about how voters choose their voting strategies, this mechanism selects the alternative that maximizes Harsanyi’s social utility function and is Pareto-efficient.     

Comparing Supports for LGBT Aging in Rural Versus Urban Areas

Studies of rural populations typically underrepresent lesbian, gay, bisexual, and transgender (LGBT) older adults. This secondary analysis examined data from a nationwide sample of LGBT baby boomers (n?=?1201). Geographic differences with respect to self-reported outness, acceptance of sexual identity, social and familial support, and household income were assessed with one-way analyses of variance. Guardedness about one's sexual identity and household asset levels were assessed with chi-square analyses. Rural individuals reported lower levels of outness, guardedness with people including siblings and close friends, and lower levels of household income. Providers should consider strategies for connecting older rural LGBT adults for potential care and support.     

Professional Perspectives on Decision Making about the Long-term Care of Older People

With the increasing pressure on social and health care resources,professionals have to be more explicit in their decision makingregarding the long-term care of older people. This groundedtheory study used 19 focus groups and nine semi-structured interviews(99 staff in total) to explore professional perspectives onthis decision making. Focus group participants and intervieweescomprised care managers, social workers, consultant geriatricians,general medical practitioners, community nurses, home care managers,occupational therapists and hospital discharge support staff.The emerging themes spanned context, clients, families and services.Decisions were often prompted by a crisis, hindering professionalsseeking to make a measured assessment. Fear of burglary andassault, and the willingness and availability of family to helpwere major factors in decisions about living at home. Serviceavailability in terms of public funding for community care,the availability of home care workers and workload pressureson primary care services influenced decision ‘thresholds’regarding admission to institutional care. Assessment toolsdesigned to assist decision making about the long-term careof older people need to take into account the critical aspectsof individual fears and motivation, family support and the availabilityof publicly funded services as well as functional and medicalneeds.     

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.     

Continuum of Care as a Policy Framework for the Social Health Care Needs of the Elderly

For some time the continuum of care has intrigued social planners and policy analysts as a concept with potential for influencing the delivery of social services. More recently, the Older Americans Act, as amended, 1978, includes the mandate to State Units and Area Agencies on Aging to provide a continuum of care for the vulnerable elderly. This state of the art review examines the continuum of care concept by isolating areas of consensus, highlighting points of disagreement, and identifying issues relevant to continuum of care as a conceptual framework for policy decisions and service delivery to the elderly population.     

Participation and health – a research review of child participation in planning and decision‐making

Effective child participation in child protection proceedings has proved difficult to achieve in Norway. Although participation is in principle accepted as a human right and something of benefit to children, when children's health is at stake there is a tendency to view participation in decision‐making processes by children as potentially disruptive to their well‐being. The purpose of this study is to review the research evidence for effects, positive or negative, of participation on health outcomes for children in care. A scoping review of major health and social work research databases was undertaken. Searches in five databases yielded 1830 studies of which 21 were finally included in this review. Studies were included if a relationship between health and participation was evident from the data presented, even if this was not the main objective in the study at hand. We conclude that when participation is successful, it may have beneficial side effects. Chief among these are that participation may improve children's safety, increase the success of care arrangements and increase feelings of well‐being for children involved. Evidence for long‐term effects of successful or failed participation attempts on subsequent health outcomes is however largely absent.     

Social Workers' Personal Death Attitudes,Experiences, and Advance Directive Communication Behavior

Abstract

This research surveyed 29 social workers to examine their personal death attitudes and experiences in relation to their advance directives communication practice behavior. The study measured death attitudes on 5 dimensions: fear, avoidance, neutral, approach, or escape acceptance of death. Participants' personal experiences with terminal illness and death were also assessed. Advance directive communication practices were operationalized as 7 phases: initiation of the topic, disclosure of information, identification of a surrogate decision-maker, discussion of treatment options, elicitation of patient values, interaction with family members, and collaboration with other health care professionals. Findings suggest that social workers' advance directive communication behavior differs by practitioners' death attitudes and experiences. Implications for social work education and professional development are discussed.     

Helping patients and physicians reach individualized medical decisions: theory and application to prenatal diagnostic testing

This paper presents a procedure designed to aid physicians and patients in the process of making medical decisions, and illustrates its implementation to aid pregnant women, who decided to undergo prenatal diagnostic test choose a physician to administer it. The procedure is based on a medical decision-making model of Karni (J Risk Uncertain 39: 1–16, 2009). This model accommodates the possibility that the decision maker’s risk attitudes may vary with her state of health and incorporates other costs, such as pain and inconvenience, associated with alternative treatments. The medical decision problem was chosen for its relative simplicity and the transparency it affords.     

Compassion Satisfaction Among Social Work Practitioners: The Role of Work–Life Balance

Abstract

Previous research has established that social work practitioners are especially vulnerable to work-related psychological distress and burnout due to the high-stress nature of the profession, yet less research has focused on examining factors are associated with social worker retention. Emerging research on compassion satisfaction suggests that this factor could mitigate professional burnout, yet there is a gap in research focusing explicitly on examining compassion satisfaction among social workers. To address this gap in knowledge, this quantitative study collected survey data on practicing social workers who were alumni from a large southeastern university (n?=?120) to examine individual and organizational factors associated with compassion satisfaction. Multiple regression analyses revealed that higher levels of emotional intelligence, perceived work autonomy, and perceived work–life balance were associated with an increase in compassion satisfaction among experienced, licensed social work practitioners. Findings have implications for how social work employers can promote compassion satisfaction through cultivating emotional intelligence among practitioners, allowing social workers autonomy in decision making, and providing supportive work environments. Recommended directions for future research include longitudinal studies with large sample sizes that expound research on compassion satisfaction by examining the role of additional factors, such as client population, job role characteristics, and supervisor support.     

Euthanasia and assisted suicide: a survey of registered social workers in British Columbia

This anonymous postal survey explores the attitudes and experiences concerning voluntary euthanasia (VE) and assisted suicide (AS) held by professionally registered members of the British Columbia Association of Social Workers. Social workers determine only a minor moral distinction between VE and AS and a large majority believe both acts should be legal, in certain circumstances (VE 75.9 per cent; AS 78.2 per cent). Approximately 80.0 per cent feel that social workers should be involved in social policy development concerning VE and AS, and, if such acts were to be legal, 70.0 per cent believe social workers should be involved in the decision making process with clients. Over 21.0 per cent of all social workers and nearly 40.0 per cent of social workers with medical employers have been consulted by a patient about VE or AS. Six respondents (1.1 per cent) reported assisting the death of a patient by VE. None had involvement in AS. Further research and education is required to better inform social work practice in this ethical area. Given the unique position of social workers in health care, they should, for the benefit of patients, families, and physicians, actively participate in the discussion concerning end of life decisions.     

Creating Supportive Environments for LGBT Older Adults: An Efficacy Evaluation of Staff Training in a Senior Living Facility

ABSTRACT

Supportive housing later in life tends to be a key concern for lesbian, gay, bisexual, and transgender (LGBT) elders. Most senior care providers are un(der)prepared to meet the needs of older LGBT adults. This study evaluated the efficacy of a 4 hours, face-to-face, research-based, LGBT-diversity training designed to improve senior housing facility staff’s cultural competency regarding the needs of LGBT elders. Findings from this study found a significant increase in LGBT content knowledge between pre- and post-intervention assessments and a significant decrease in perceived preparedness when working with LGBT elders. These effects remained significant after controlling for staff designation, religion, educational attainment, and training session. Findings suggest that staff’s cultural competence affected their perceived readiness to address LGBT elders’ needs. Implications are related to the concept of cultural humility or the lifelong process of understanding others’ experiences based on the recognition of lack of un(der)preparedness to create a culturally supportive residential environment.     

Dynamic Choice and NonExpected Utility

This paper explores how some widely studied classes of nonexpected utility models could be used in dynamic choice situations. A new "sequential consistency" condition is introduced for single-stage and multi-stage decision problems. Sequential consistency requires that if a decision maker has committed to a family of models (e.g., the multiple priors family, the rank-dependent family, or the betweenness family) then he use the same family throughout. Conditions are presented under which dynamic consistency, consequentialism, and sequential consistency can be simultaneously preserved for a nonexpected utility maximizer. An important class of applications concerns cases where the exact sequence of decisions and events, and thus the dynamic structure of the decision problem, is relevant to the decision maker. It is shown that for the multiple priors model, dynamic consistency, consequentialism, and sequential consistency can all be preserved. The result removes the argument that nonexpected utility models cannot be consistently used in dynamic choice situations. Rank-dependent and betweenness models can only be used in a restrictive manner, where deviation from expected utility is allowed in at most one stage.     

My life in care: experiences of non-participation in decision-making processes

The extent to which young people are involved in legal decision‐making depends on assumptions and perceptions about their ability to participate in decision‐making in general. This paper draws on research with four young people, looking at their experiences of involvement in a variety of decision‐making processes whilst in the care of the local authority. Through narratives, games and other activities, the thoughts and emotions of the four young people are explored, identifying the development of feelings of helplessness, low self‐esteem and poor confidence that have followed the lack of opportunities made available to them to make decisions about their own lives. The efficacy and tension of corporate parenting is also explored with suggestions from the participants on how the care system could be constructed differently to facilitate their voice and that of much younger children than themselves. Thus, the debate becomes one of adult ability and preparedness to involve young people in decisions about their own lives, rather than whether they are able to participate effectively.     

Allocating limited health care resources – the tragedy of patient relations with the mass media

The allocation of limited resources for social welfare purposes, including health care, may be distorted by publicity in the mass media. Acting on behalf of a personified welfare customer, the results of the media coverage may instead be distortions in the distribution of resources. An actual case and stylized examples are used to indicate that the willingness to pay for health care depends on the distance between customer and decision-maker. The role of the mass media in serious medical treatment decisions is then discussed.     

Today's Studies,Tomorrow's Meta-Analyses: Implications for Evidence Informed Decision–Making in Social Work

ABSTRACT

Meta-analyses play an important role in understanding aspects of human functioning and program effectiveness. Meta-analyses also inform practice and policy decision making in areas of interest to social work. This study examined the degree to which recent quantitative reports in top social work journals are eligible for inclusion in future meta-analytic studies based on method rigor. The results suggest a mixed picture. Articles in top social work journals typically present sufficient information on participant characteristics, p values, and Mean values, yet they often fail to present sufficient information on variance indicators or the precise numbers of participants, which limits the ability to calculate effect sizes. Furthermore, less than 10% of the reports utilized randomized experimental designs or tested for group equivalence. To enhance social work's ability to make evidence-based decisions by producing more meta-analyses, researchers should provide more detail in study reports and use stronger research designs.