Rising to the Challenge of Treating OEF/OIF Veterans with Co‐occurring PTSD and Substance Abuse

This article reviews data on the relatively high incidence of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans reporting mental health and substance abuse problems, and some perceived barriers that may account for low rates of their engaging in treatment. Treatment outcomes for veterans with co‐occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) are generally poorer than for those with PTSD or substance abuse alone. Several evidence‐based individual therapy approaches offered by VA Medical Centers are described along with how they conceptualize the relationship of substance abuse to PTSD. Problems with sequential treatment for persons with PTSD and substance abuse in specialized programs are discussed, including notably the practice of requiring veterans to be completely drug and alcohol free for a month or longer prior to entering PTSD treatment. Several integrated treatment programs are described along with a brief summary of evidence supporting their effectiveness. Some recent policy changes from the Department of Veterans Affairs that bode well for the future of PTSD/SUD treatment are described. Differences between younger and older veterans were cited along with their implications for treatment. Recommendations regarding how to better engage and retain OEF/OIF veterans with PTSD/SUD in treatment are presented together with examples of their implementation. The author concludes that to rise to the challenge of treating this difficult population it is necessary to adapt treatment to meet their needs rather than requiring them to adapt to therapies that may not be a good fit.     

Gang membership and bias against young people who break the law

High school students (n=148), college students (n=98) and adult church members (n=108) reacted to vignettes depicting an illegal act by a young person: spray painting a wall (malicious mischief) or pointing a handgun at another person (felony menacing). In a randomized 2 × 2 × 2 × 2 factorial design, manipulated variables were perpetrator as male/female, as Hispanic/not, as a gang member/not, and perpetrator accompanied by other young people versus alone. Church members perceived greatest danger, were most likely to report the incident, but high school students were the most punitive. The mischief vignette showed subjects were less likely to confront gang members, perceived them to be more dangerous, were more likely to report them to police, and more were likely to advocate locking them up. This bias was not observed in the menacing vignette. Perhaps greater seriousness of the incident overwhelmed the salience of gang membership.     

Contexts of Mother–Child Separations in Homeless Families

Families that contend with the losses, disruptions, and hardships occasioned by homelessness often experience dispersal of children as well. Although a federal initiative on homeless families identified family preservation as a focus of intervention development, there is little research to guide service efforts. This qualitative study of mother–child separations in homeless families with maternal mental health and/or substance use problems identifies precursors of separations (precarious housing, turbulent relationships, substance abuse by mothers and others, institutional confinement, and children's needs) and examines how mothers' responses to these events and conditions interact with social and institutional contexts to shape variations in the course and outcome of separations. Implications for research, services, and policies affecting homeless families are discussed.     

Hearing the Voices of Abused Older Women

Summary

This paper focuses on a qualitative research process that gathered responses from 64 older women aged fifty and older on their experience of violence and abuse. What older women said about abuse in their lives supports the use of a feminist framework as well as the age based analysis of the elder abuse field. Some respondents spoke of abuse from childhood into their later years. Some spoke of partners witnessing or experiencing abuse as children. Some women express concern about possible abuse by their adult children of their own children.

Abused older women like younger women need a safe environment, emotional support, advocacy, information, and peer support. While it is important to consider the perspectives and knowledge of service providers when developing policy and practice on abuse of older women, it is critical to ask the women survivors of abuse or neglect what they believe would benefit them, and others in similar situations.     

Assessing Health Care Needs Among Street Homeless and Transitionally Housed Adults

ABSTRACT

This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral health care services. Nearly a third of participants reported current unaddressed health problem(s); an inability to obtain needed health care; and feelings of unaddressed mental health issue(s) as well as substance abuse problem(s) in the past year. Future research on homelessness and health should focus on identifying different pathways to health and mental health services for this vulnerable population and the outcomes of these interventions.     

Hearing the voices of abused older women

This paper focuses on a qualitative research process that gathered responses from 64 older women aged fifty and older on their experience of violence and abuse. What older women said about abuse in their lives supports the use of a feminist framework as well as the age based analysis of the elder abuse field. Some respondents spoke of abuse from childhood into their later years. Some spoke of partners witnessing or experiencing abuse as children. Some women express concern about possible abuse by their adult children of their own children. Abused older women like younger women need a safe environment, emotional support, advocacy, information, and peer support. While it is important to consider the perspectives and knowledge of service providers when developing policy and practice on abuse of older women, it is critical to ask the women survivors of abuse or neglect what they believe would benefit them, and others in similar situations.     

The Influence of Client Age on Clinical Judgements of Male and Female Social Workers

Social workers were presented with a clinical vignette in which client age was systematically varied. There were no differences in ratings of older and younger clients on prognosis or pathnology. The older client was not seen as less ideal or more organically impaired, and treatment recommendations did not differ. However, female social workers attached significantly less importance to psychodynamic issues for the older client than the younger.     

Impact of the Village Model: Results of a National Survey

ABSTRACT

Villages are a relatively new, consumer-directed model that brings together older adults in a community who have a mutual interest in aging in place. These membership organizations provide social and civic engagement opportunities, volunteer provided support services, and referral to vetted community providers to achieve their primary goals of promoting independence and preventing undesired relocations. This cross sectional survey of 1,753 active Village members from 28 Villages across the US measured members’ perceived impacts in the areas of social connection, civic engagement, service access, health and well-being, and ability to age in place. Results showed that involvement in the Village was a key factor associated with greater perceived impacts. Over half of members perceive that the Village has improved their sense of connection to others and their feeling that they have someone to count on. Though younger members in better health were more likely to perceive impacts in social connections, results suggest older women, living alone with some disability may be the most likely to experience improved health, quality of life, and mobility. The implications for social work practice are discussed.     

The emerging role of Financial Counsellors in supporting Older Persons in financial hardship and with management of Consumer‐directed Care packages within Australia

The role of financial counsellors as providers of information, support and advocacy for those in financial difficulty is a well established mechanism in the mainstream welfare landscape in Australia. In general, the role of financial counsellors is in helping people alleviate or resolve their financial difficulties through improvement of their financial literacy. It is recognised as an important component of policy responses to assist low‐income households and individuals in financial stress. The use of financial counsellors for older persons (i.e., those aged 65+ years), however, appears to be underutilised. Financial hardship and abuse of older persons within our community are becoming key issues as the population of Australia “ages”. Existing evidence also suggests that service providers alone do not have adequate skills to address these issues. This paper firstly examines the development of financial counselling in Australia. It then examines the newly emerging role of financial counselling in supporting older persons in addressing barriers to financial literacy and then in navigating the complex landscape of aged care service provision. The current financialisation, marketisation and complexities of consumer‐directed care are identified as key contextual factors. The paper will then discuss an evaluation study of the provision of financial counselling to the older person population designed to support financial hardship and navigation of the complex aged care services system. The findings of the paper are based on an evaluation of the Financial Consumer Rights Council (FCRC), Victoria: Dignity and Debt Financial Difficulty and Getting Older initiative. This pilot initiative included older persons from both community‐based and aged care residential facilities in one regional area of Victoria. The initiative, conducted over 2016, was designed to assess the effectiveness of one‐on‐one financial counselling sessions with older persons that provided consumer advocacy and information about support services and entitlements (including hardship protections) associated with ageing. The evaluation found that the provision of financial counselling to the older person population could be a key mechanism in improving overall financial literacy, avoiding periods of financial hardship and in maintaining financial well‐being, quality of life and positive ageing. Findings also demonstrated a need for an expanded outreach financial counselling model to better service older persons in more isolated living environments and/or with mobility impairments living in the community, and the potential to situate offices of financial counsellors within medical centres (a space often visited by the ageing population), to co‐situate financial health check‐ups as an overall element of health and well‐being. As such, financial counselling was viewed as well placed to support older persons in improvement of financial literacy and in supporting navigation of the increasingly complex marketised and consumer‐directed care (CDC) landscape of aged care service provision in Australia.     

Baby Boomer’s Substance Abuse and Researcher Indifference

The current older adult population is more likely to need and seek treatment for alcohol and drug abuse than previous cohorts of older adults, which necessitates the need for age-appropriate substance use treatment. Building on previous research that examined the lack of attention on substance use among older adults, this study examines articles addressing substance use disorders among older adults in leading gerontological and substance abuse journals and federal funding between 2011 and 2017. Publications were identified from ten leading gerontological and ten leading substance abuse journals using Medical Subject Heading (MeSH) terms. During this time-period, there were 68 and 44 articles published in gerontology and substance abuse journals respectively related to substance use disorders in older adults. Most (59.8%) addressed alcohol abuse and 7% involved intervention studies. In the 7-year period, there were 13 federal grants. A paucity of published or funded work exists in this area despite growing misuse and treatment seeking among older adults with substance use disorders. Effectively addressing substance abuse in older adults will require a coordinated effort between researchers and practitioners to establish and implement best practices for practitioners to rely on when working with substance abusing older adults.     

Older Latina Women and HIV/AIDS: An Examination of Sexuality and Culture as they Relate to Risk and Protective Factors

Older Latina women are one of the least studied American demographic groups with regard to social, health, or sexual behavior. This could leave social workers and other geriatric professionals unprepared for dealing with HIV/AIDS in this population. Currently, older Latina women are one of the fastest growing groups of new AIDS cases. Twenty percent of all women ever diagnosed with the disease are Latina and 5.5% of Latinas infected with the virus are older. The number of diagnosed infections is increasing in older women, including Latinas, in spite of recent declines in infection rates with younger populations. There are also a potentially large number of cases that go misdiagnosed or undiagnosed.

This article also addresses risk and protective factors related to gender roles, traditional Latino family values, religion, socioeconomic factors, health, and health care, with special attention to the triple jeopardy faced by this population by virtue of being female, seniors, and minorities. The article concludes with recommendations for the development of culturally competent practices with older Latinas and the development of a research agenda to better understand their risk-related and health-seeking behavior.     

Senior Services that Support Housing First in Metro Vancouver

Housing First is a model and philosophy for housing homeless people in immediate and permanent housing. In order to implement and deliver Housing First, research is essential to understand the system of support services as they currently exist. Guided by principles of community-based participatory research, this paper presents the findings from a senior-focused deliberative dialogue workshop in Metro Vancouver, Canada. Participants (16 service providers and 1 service recipient) identified services and resources available to support seniors in maintaining housing and barriers and facilitators for accessing services. Broadly, data were organized into seven themes: (1) Housing; (2) Home support; (3) Transportation; (4) Information availability, accessibility, and navigation; (5) Cultural diversity; (6) Discrimination; and (7) Funding and financial support. Results found that affordable housing that adapts to changing health conditions, income supports, health services, homecare, transportation, and culturally appropriate and nondiscriminatory informational resources are among the supports most needed for persons as young as 50 years old to succeed under the Housing First model in Metro Vancouver. Barriers to Housing First service provision, including rigid eligibility criteria for chronically and episodically homeless, should be revised to better support the growing number of older adults who are newly entering homelessness in Metro Vancouver.     

Too old to test? Prevalence and correlates of HIV testing among sexually active older adults

ABSTRACT

Older adults account for 17% of new HIV diagnoses in the US and are more likely to be diagnosed with HIV later in the course of the disease compared to younger people. We calculated the prevalence and associated factors of having ever been tested for HIV among sexually active older adults. We analyzed data from the 2008–2016 General Social Survey Limited to respondents ≥65 years of age who reported more than one sex partner(s) in past 12 months (n = 757). HIV testing prevalence, prevalence ratios, and 95% confidence intervals were calculated by demographic variables and HIV-related risk behaviors. An estimated 16.3% of sexually active older adults have tested for HIV, and 15.9% were at increased risk for HIV infection (reported injection drug and/or crack–cocaine use, exchanging money for sex, more than three sex partners in the past year, or men who reported having sex with another man). In the adjusted model, adults aged 65–70, not married, self-identified as gay/bisexual, and at increased risk for HIV infection were more likely to have tested for HIV. An estimated 83.7% of sexually active older adults never tested for HIV. Strategies are needed to increase HIV awareness and testing among potentially high-risk older adults.     

Ability of the Behavioral Model to Predict Utilization of Five Services by Individuals Suffering from Severe Mental Illness and Homelessness

Abstract

This study examined the ability of the behavioral model to predict utilization of five specific services in a sample of individuals who suffered from severe mental illness and who were homeless at baseline. Nearly 4000 individuals from 18 sites provided data at baseline and 12 months later for this study. Hierarchical logistic regression was used to analyze the data. The behavioral model did not explain much of the variance of utilization of medical services, housing services, and public support. The behavioral model did explain a moderate amount of the variance of utilization of psychiatric services and substance abuse services. Enabling variables explained more of the variance of psychiatric services than either predisposing or need variables. In contrast, predisposing and need variables explained more of the variance of utilization of substance abuse services than enabling variables. Social support from professionals and self-perceived need for service were the most consistent predictors of all of the service utilization variables.     

Violence Across the Lifespan: Interconnections Among Forms of Abuse as Described by Marginalized Canadian Elders and their Care-givers

Elder abuse is recognized as a major problem, with profoundeffects on the health and quality of life of older persons.In our aging population, elder abuse represents an escalatingclinical issue for social workers and health care professionalswho provide care to older people. A major gap in our examinationof elder abuse is the potential contribution and applicationof knowledge developed within research derived from other formsof family violence. This paper explores the interconnectionsamong various forms of violence across the lifespan, and theexperiences voiced by marginalized elders and their care providers.We interviewed seventy-seven rarely consulted older adults andforty-three formal and informal care-givers of older adultsin focus groups in Ontario and Alberta, Canada. Study findingsrevealed four major themes that describe interconnections amongtypes of abuse: (i) intergenerational cycles of abuse; (ii)violence across the lifespan; (iii) exposure to multiple subtypesof elder abuse; and (iv) ongoing spouse abuse that shifted intoelder abuse. The results from this study indicate that victimsoften ‘suffer in silence’ and cultural factors,ageism and gender are ubiquitous to elder abuse. Recommendationsto reduce elder abuse include education, formal and informalsupports and services.     

The Willingness of Persons 60 or Over to Volunteer

This investigation examined persons 60 or over concerning their willingness to engage in volunteer activity. Volunteering was defined as contributing one's time without pay to non-profit organizations in the community. Of the 56 non-volunteers interviewed, a startling 59 percent expressed a willingness to volunteer and a main reason given for not volunteering was simply that no one has asked them. Older persons have historically underutilized and/or have been undersewed by the social service network in the community. Results of this and other investigations indicate that there is a significant group of older volunteers and potential volunteers waiting to be asked who can be used to bridge this service gap.     

Factors Associated With Productive Engagement Among Older South Koreans

ABSTRACT

 Although positive relationships among health, types of activities, and productive aging have been documented in Western industrial nations, little attention has been paid to rapidly developing countries. This study examined unique factors using national South Korean data. Community-dwelling adults aged 55 years and older (n = 6,688) were drawn from Wave II of the Korean Longitudinal Study on Aging. Binary logistic regression analysis was conducted to identify the main and interaction effects related to labor force participation (LFP) and lifelong-learning participation (LLP). Whereas one third (34.4%) of the respondents were involved in LFP, LLP was extremely low (6.8%). Health and socioeconomic status were significant in conducting LFP and LLP. Depression and cognition contributed to LFP but not LLP. Older men who reported higher levels of depression were less likely to engage in LLP than were their female peers. For female respondents, the social activities of exercise and alumni meetings contributed to the likelihood of LLP. Given the lower socioeconomic characteristics and low participation in lifelong learning, it is essential to establish financial incentives to encourage activity participation and develop programs to promote productive aging in South Korea. Future studies should consider the impact of environments and social policy on productive engagement.     

Physical and Sexual Abuse,Battering, and Substance Abuse

Abstract

Women born before 1945 are the older women of today. Many of these women were subjected to childhood physical and sexual abuse and spouse battering at a time where there were no laws to protect them and few people discussed such subjects. Some of these women became substance abusers or lived with substance abusers. While there are retrospective studies on the experiences of adult women who suffered abuse in the family, little is known about the experiences of women over the age of 60 years.

Similarly, there is information on substance abuse among young and middle-aged women, but very little information on or about older womens' experiences with substance abuse. In this study, we review the literature on abuse and substance abuse. We present three clinical cases of older women who have experienced various forms of abuse and who in turn abuse substances. The cases are analyzed. Assessment, treatment, and evaluation methods for social workers are discussed.     

Youth Experiences Survey (YES): Exploring the Scope and Complexity of Sex Trafficking in a Sample of Youth Experiencing Homelessness

ABSTRACT

In the United States, sex trafficking victims have been identified at ages across the lifespan but young persons (under age 25) have been found to have unique vulnerabilities. At-risk youth, such as those who run away from home or those experiencing homelessness, are also at an increased risk of sexual exploitation. To better understand the scope and complexity of sex trafficking among these at-risk youth, a convenience sample of 131 homeless youth aged 12 to 25 years old experiencing homelessness recruited from Kentuckiana youth service providers completed an enhanced version of the Youth Experiences Survey (YES). Univariate and bivariate analyses were conducted. Results indicated that 41.2% of the homeless youth were victims of sex trafficking. The sex trafficked youth were more likely to report previous self-harm behaviors, suicide attempts, and substance use. This study not only provides support for improved service delivery, but also provides essential statistics that should inform internal policy and procedures for youth serving agencies in Kentucky and Indiana. Findings highlight a need for trauma-informed interventions designed to treat not only females but also males and LGBTQ youth. Additionally, service providers should consider partnering with victim providers and clinicians to offer therapeutic groups, individual therapy, and supportive services that increase prevention, education, and wraparound care for clients. In regards to future research, findings point towards a need to better understand the role that trauma and adverse childhood experiences may play in making young people vulnerable to sex trafficking, and encourage the need for testing prevention and early intervention practices among vulnerable youth.