Ethics at the End of Life: A Teaching Tool

ABSTRACT

Social workers rarely receive education and training in the areas of grief, bereavement, and death and dying, which may lead to difficulties in compassionately and ethically addressing concerns in end-of-life or grief-related contexts. This article presents actual and potential outcomes from three challenging end-of-life case studies using Mattison’s ethical decision-making model as a framework. The case studies were drawn from student interviews with experienced master’s-level social workers. This pedagogical article helps to promote self-reflection and consideration of ethical issues in grief and death-related situations as well as supplement death education and ethics curricula to include end-of-life content.     

The Interview for Decisional Abilities (IDA): a tool to assess the decisional capacity of abused and neglected older adults

We present the Interview for Decisional Abilities (IDA), a semi-structured tool for use by adult protective services (APS) workers as part of their comprehensive assessments of clients. The IDA was created in response to a Federal mandate to standardize the procedures and competencies of APS agencies with a view to improving client assessments and facilitating cross-jurisdictional research on adult mistreatment. The proximal aim of the IDA is to guide workers in gathering information on the ability of suspected victims of adult mistreatment to make decisions about the risks they face.     

Managed care. The effect of case management on state psychiatric clients.

This study examined whether case management services, mandated under the managed care contract for adult clients in a medium-sized state psychiatric hospital in Tennessee between July 1996 and June 1997, were offered as specified, and the impact these services had on recidivism for individuals who were identified as having a severe or persistent mental illness. Although all of the clients were offered case management, 47% refused the service. Of the 14 who had one or more readmissions, six (43%) had case management. These findings demonstrate that health care providers must offer sufficient information to their clients so that they can use the managed care system more effectively.     

A National Study of Involuntary Protective Services to Adult Protective Services Clients

ABSTRACT

A questionnaire was sent to state administrators of Adult Protective Services Programs (APS) to learn about involuntary protective services provided by APS to vulnerable adults at risk of abuse, neglect, or exploitation. Data were obtained on criteria used to assess the need for involuntary services, types of services provided, sources of authority for involuntary intervention, the nature and extent of public concern about involuntary services, and the protection of the rights of incapacitated clients. Based on responses from 43 states, less than 10 percent of APS recipients receive services without their consent; and all states providing services involuntarily take steps to ensure the protection of rights. Available information from the study does not support the general belief that adults who self-neglect are more likely than other APS clients to have protective services imposed.     

Cultural perspectives of death,grief, and bereavement

The cultural makeup of the United States continues to change rapidly, and as minority groups continue to grow, these groups' beliefs and customs must be taken into account when examining death, grief, and bereavement. This article discusses the beliefs, customs, and rituals of Latino, African American, Navajo, Jewish, and Hindu groups to raise awareness of the differences health care professionals may encounter among their grieving clients. Discussion of this small sample of minority groups in the United States is not intended to cover all of the degrees of acculturation within each group. Cultural groups are not homogeneous, and individual variation must always be considered in situations of death, grief, and bereavement. However, because the customs, rituals, and beliefs of the groups to which they belong affect individuals' experiences of death, grief, and bereavement, health care professionals need to be open to learning about them to better understand and help.     

Mapping Elder Mistreatment Cases: Interactions Between Mistreatment,Dementia, Service Utilization,Access to Services,and Disadvantage

Typical explanations of elder mistreatment have focused on individual-level models. The current study adds to the literature by considering the neighborhood context in which reports of elder mistreatment are made to protective services. Using geographic information system software, the distribution of 751 adult protective services (APS) reports from three cities in southeastern Virginia is analyzed. Results suggest that Alzheimer's cases are distributed differentially across cities and that in one city, reports primarily come from disadvantaged areas. The results also suggest that clients from disadvantaged areas are more likely to refuse services. Implications for policy, theory, and future research are provided.     

Creative Solutions and Development for Social Workers Treating People with Serious Mental Illness - Contributions from Supervision

Social workers who are engaged in a therapeutic work with clients who have serious mental illness often face specific challenges and find themselves in crisis states in therapy, which stem from the return of the clients’ symptoms and their cognitive impairments as well as social stigma. These crisis states cause dramatic changes in the way social workers mentalize their clients and they are propelled to draw from covert, unformulated, and dissociated knowledge that they have about the client’s experience, which contributes to achieving new, surprising, and creative ways to mentalize the client. Such crisis resolutions enhance therapists’ personal and professional development and serve as an identification model for their clients.     

An Adult Protective Services' View of Collaboration With Mental Health Services

Mental Health Services (MHS) meet mental health needs of older adults through active, outpatient, community-based care. Adult Protective Services (APS) are involved with needs of older adults who have mental disability and mental illness. Adult Protective Services and MHS staff may to work together when they respond to the needs of victims and adults at risk for abuse, neglect, self-neglect, and exploitation. The purpose of this study was to understand effective APS–MHS collaborations (e.g., leadership, organizational culture, administration, and resources in predicting success). A survey that was sent to members of the National Adult Protective Services Association (NAPSA) revealed that both APS and MHS have strong commitments to protecting clients' rights and autonomy, but there appear to be differences between the two with regard to implementation, apparent in cases involving clients with diminished mental capacity who are at imminent risk, but who refuse help. Strengths of APS–MHS collaborations included improved communication and better service for at-risk clients.     

Some Questions for Linda Mitchel on Loss and Bereavement

Resolving loss is the theme of this issue's interview. Linda Mitchell offers something in her employee counseling services that more employee assistance specialists need to address - helping clients better understand and resolve the sense of loss. She is a skilled psychotherapist with a specialty in counseling on "loss-related issues." She has designed and conducted support groups dealing with issues such as bereavement, self-esteem, job loss. As a skilled psychotherapist she has provided counseling and education to families experiencing a death of a loved one. In addition to seeing chemically dependent clients in her practice, she has experience counseling people with AIDS. Another part of her practice a assisting individuals in dealing with various life issues such as a change in a job position, or the loss of employment.     

The need to know caregiver perspectives toward using smart home technology

This article reviews the literature on adults with serious mental illness, their caregivers, and smart home technology. The article provides compelling evidence for social workers to undertake research aimed at investigating caregivers' perceptions toward using smart home technology for care of adult family members or friends with a serious mental illness. Empirical support for using smart home technologies with adults with serious mental illness is provided, and recommendations for future social work research are offered.     

Spirituality in Social Work Practice

This article traces the origins of spirituality in clinical social work and psychotherapy from the nineteenth century to contemporary practice. Cases involving bereavement, terminal illness, and immigration often incorporate spirituality into traditional treatment. The author discusses his own spiritual journey, and the incorporation of spirituality into his work with agency-based clients. He also draws a distinction between religion and spirituality, noting the importance of including the latter into work with interested clients.     

Proper Documentation:

Over the past decade, almost all states in the U.S> have passed legislation related to elder abuse. Most of the legislation mandates that Adult Protective Services (APS) workers assess the validity of reports of alleged elder abuse or neglect. Some states also mandate these workers to plan and manage services aailable to victims. Assessing and serving victims and their families requires that APS workers have knowledge and skills in many areas. One important skill is properly documenting the assessment process. In this paper, a case is made for including proper documentation as an important topic in any APS training prorgam. Then, a systematic method is suggested for training APS workers in how to document their assessments of cases.     

Observing Different Faiths,Learning About Ourselves: Practice with Inter-married Muslims and Christians

Abstract

Advanced care planning and end-of-life decision making are part of contemporary debates about death and dying. A data-mining study reviewing medical records of patient deaths in hospital investigated these issues and the utilisation of social work services. Findings indicated that the majority of records included some form of documentation about end-of-life care, including cardio pulmonary resuscitation (CPR) orders and that family members and surrogate decision makers were more likely to be consulted than patients about these plans. The incidence of referrals to social workers was found to be highest “out-of-hours”. Key social work interventions were identified, including establishing the reliability of surrogates' decisions through social work assessment. This paper discusses elements that contribute to a supportive environment for patients and family members to facilitate the decision making process, including the need for a broader ethical discourse to accommodate the increasing complexity of end-of-life decision making in hospital settings.     

The devil is in the details: self-neglect in Australia

Although elder self-neglect is of significant concern to adult protective service (APS) workers in the United States, minimal research has been conducted on this topic in Australia. Using qualitative research methods, this article examines how 24 Australian professionals understand situations of self-neglect. Unlike in the United States, where the term self-neglect is used in a broad and all-encompassing manner, participants in this research differentiated among self-neglect (the neglect of self), squalor (extreme neglect of environment), collecting (the accumulation of certain objects), and hoarding (the inability to throw objects away). It is argued that separating out the various behaviors that are classified under the broad umbrella of neglect can be useful in fostering reflective interventions in these situations.     

The Social Relationships and Social Support of Aging Mothers Whose Adult Daughters Are Mentally Ill

Guided by a conceptual framework highlighting multiple facets of social relationships and social support, this study examined the extent to which aging mothers of adult daughters with a serious mental illness were socially integrated with members of their network. It further examined the relational content of these mothers’ social ties as tangible or intangible support and the nature of their supportive exchanges with network members, particularly their adult daughters with mental illness. A structured face-to-face interview was conducted with 22 aging mothers of these adult daughters. Two methods of analysis were used to analyze data: counting and content analysis. Findings showed aging mothers of daughters with mental illness were socially integrated with relatives and nonrelatives, evidenced relational content of tangible and intangible support in their social ties and engaged in bidirectional and asymmetrical support exchanges with network members, including their daughters with mental illness. These findings suggest that social resources in the form of social relationships and support are embedded in the networks of aging mothers who have adult daughters with serious mental illness. Practitioners should assess support contributions to the aging mothers of adult daughters with serious mental illness from a wide range of social relationships including their daughters.     

Discretionary approaches to social workers’ personalisation of activation services for long-term welfare recipients

Contemporary social policies emphasise labour market inclusion of vulnerable groups through personalisation of activation services. This article investigates social workers’ decision-making when personalising activation measures to suit each client. Data consist of case files for 16 clients participating in a Norwegian activation scheme, and interviews with the clients’ designated social workers. Using Bakhtin’s theory of dialogism, the article examines what the social workers consider in their decision-making process and the pivotal factors in their conclusions. Findings show that social workers employ two distinct approaches to personalisation, which have significantly different implications for clients’ pathways towards labour market inclusion. The first approach concentrates on clients’ personal challenges, while the second focuses on feasible short-term employment strategies. The study demonstrates how institutional and political frameworks may lead to social workers’ posing activation requirements inconsistent with clients’ needs and capabilities. It suggests further research into these interrelations to improve social workers’ ability to adapt services to individual clients.     

Characteristics of Adult Protective Services Social Workers

Profiles of victims and perpetrators of elder abuse appear in the literature, but no profile of adult protective service (APS) workers has previously been developed. This paper compares data on demographics (age, race, gender), employment history, professional preparation, continuing educational needs, and sources of stress on the job gathered from a survey of 580 public service social workers in North Carolina, 218 of whom reported primary or secondary responsibility for APS and 232 of whom reported incidental or no responsibility for APS.     

Use of standardized client simulations in an interprofessional teaching concept for social work and medical students: first results of a pilot study

ABSTRACT

Teaching concepts with standardized clients/patients (SC) had been successfully implemented in the education of health professionals. Benefits were also demonstrated for social work education. Based on former experiences with simulated clients in medical education, we developed an innovative teaching concept for social work and medical students. We focused on the training of consultations with clients suffering from a serious illness like cancer—with different learning goals for medical students (e.g. breaking bad news) and social work students (e.g. psychosocial exploration and counseling). Both groups should gain knowledge about the other professions tasks and learn to handle clients’ emotional reactions. In addition to role-plays with simulated clients in small groups, the concept includes an interprofessional lecture by physicians, psychologists, social workers, and lawyers as well as a visit on the palliative care ward (for social work students only) and a research colloquium. A formative evaluation shows high satisfaction with the teaching concept. The students underline the realistic setting, interprofessional contact, authentic talks and direct feedback. The SC method and its interprofessional application proved to be a practicable and motivating way to enhance conversational skills.