Overcoming Ungrievability: Transgender Expectations for Identity after Death

Butler (Precarious Life: The Powers of Mourning and Violence. London, UK: Versa; 2004) observed cultural shifts immediately after 9/11 and suggested that, with regard to grievable and ungrievable lives, societal power structures “produce and maintain certain exclusionary conceptions of who is normatively human” (p. xiv–xv). The current study brings new understanding to the concept of grievability by exploring the symbolically violent de-transitioning of trans people after their deaths. The aim of this exploratory study was to examine the thoughts and attitudes of older trans people (40 y. o. plus) with regard to the phenomenon of nonconsensual de-transitioning after death and the expectations they have regarding the expression of their own identity after death. The wishes of the participants were grouped into four outcome categories: hoping to be memorialized only as their lived identity (25%); only as their identity-assigned-at-birth (6%); as both identities combined (44%); and those who claimed that they did not care how their identity was memorialized (25%). Our findings serve to emphasize the importance of open and honest end-of-life communication as well as to underscore the diverse nature of the transgender population and the complexity of the transgender identity.     

Deploying an Ecological Model to Stem the Rising Tide of Firearm Suicide in Older Age

A central objective of the Surgeon General’s National Strategy for Suicide Prevention is to focus on older adults. We review individual risk-factors for suicide in late life and then introduce an ecological model to expand conceptualization of elder suicide. We first look at the role of firearms, providing evidence that firearm availability increases the means of elder suicide and gun access policies can contribute to reducing risk. Next, we focus on primary care providers, documenting how older adults often come into contact with these professionals before ending their lives and how these providers could take a more active role in mediating individual-level risk factors. We then turn our attention to the intersection between gun access and primary care and consider how advancing standards of care concerning gun access and suicide risk might be an effective policy alternative for blocking the pathway to suicide among older adults.     

Issues Affecting Utilization of Hospice Services by Rural Hispanics

Abstract

As the population of Hispanics in the U.S. is growing, their utilization of hospice care remains low. In a study of 110 rural His-panics, most (88%) were not familiar with hospice, but did report willingness to accept such service in their homes. The most important possible barrier to receiving hospice care was language, along with poverty, lack of health insurance, and low levels of education. Hospice social workers can contribute greatly to an effort to increase access to hospice by offering education to the Hispanic community and promoting cultural awareness among hospice staff.     

Personal and Professional Knowledge of and Experience With Suicide and Suicide Prevention Among Stakeholders in Clinical and Community Practice

Community-dwelling veterans at risk for suicide may be in contact with a variety of providers in agency-based settings that offer health and human services. The study aim is to describe the perspective of agency-based clinical and community providers who may come into contact with veterans in need of suicide prevention services and to examine the nature of their personal and professional relationships to individuals at risk for suicide among this sample.

This study reports on qualitative data from a sample of Veterans’ Affairs (VA) and community providers serving veterans and military families in one Midwestern state (N = 70). Providers completed a survey assessing exposure to suicide, including contact with and relationship to someone suicidal, and organizational characteristics of the providers’ employing agencies. Semi-structured interview questions probed for the nature of how they would react with suicidal individuals. Most providers (94%) had some prior contact with someone who was suicidal, and nearly three quarters (77%) knew someone who had died by suicide. Providers reported powerful emotional responses of sadness and remorse to suicidal experiences. While these providers interact with veterans and military families as part of their jobs, they may have their own history of being exposed to suicide, both professionally and personally.     

Perspectives of Young People in Care About their School-to-Work Transition

Abstract

Achieving in education and employment has long-term effects on quality of life. With below-average levels of educational attainment, many young people in care are ill-equipped for the transition from school to further education and work. This paper presents findings from a qualitative study that explored the school to work transition experiences of young people currently or previously in care, and their ideas about future employment. A range of personal and contextual factors that influence study and work goals were identified. Young people spoke about the importance of personal confidence and determination, supportive relationships, someone to believe in them and encourage them, opportunities to pursue their goals, avenues to gain information about how to get desired jobs, positive school experiences, and the need for stability in their lives. The study suggests widening the agenda for case planning, transition from care and after-care support, to include career planning and vocational assistance.     

Blessed assurance: The role of religion and spirituality in Alzheimer's disease caregiving and other significant life events

Increasing attention in the scientific literature is being given to the relationships among religion, spirituality, and overall well-being. Moreover, research has repeatedly identified religion and spirituality as significant coping resources throughout the life course. For this study, a group of 20 Catholic and Protestant older adults were interviewed; half were caregivers of a spouse with Alzheimer's disease and half were noncaregivers. The informants were asked about their views on religion, spirituality, and how they integrated their faith into their lives. Qualitative analysis identified several themes reinforcing previous work that has shown religion and spirituality are important dimensions to the human experience. All of the informants had integrated religious and spiritual beliefs and practices into their lives to help make sense out of stressful situations. The findings underscore the need for further scientific inquiry that examines how religion and spirituality promote healthy adaptation to significant life events.     

IT'S MY WORLD?

A positive sense of control over one's life is essential for maintaining health and well-being. Those with a strong sense of control believe changes in their social world are responsive to their choices, actions, and efforts. In contrast, a sense of powerlessness or fatalism is on the other end of the continuum. There is little research that explores how race and gender relate to feelings about personal control. To examine their effects on perceptions of personal control, we analyze data from the American Changing Lives Survey, 1986. Controlling for race and gender in the full model led to results that failed to reveal the complexity of relationships when compared with results of analyses among the subgroups. Some key factors distinct for the various groups were, for white men, functional health, positive support from friends and relatives, and having people to share their feelings with; for black men, age and visiting mental health facilities; for white women, visiting medical care facilities, the number of children, tobacco, and having someone to call for help; and, for black women, being involved with organizations (groups, clubs, and churches) and religion. When there are no significant racial or gender differences, examining models simultaneously stratified by race and gender introduced a more dynamic and multidimensional relationship between the control and dependent variables than was previously understood.     

Links between past abuse,suicide ideation,and sexual orientation among San Diego college students

The authors explored relationships among childhood abuse, suicidal ideation, and sexual orientation of 18- to 30-year-old students enrolled in 2 San Diego area colleges, using responses from anonymous questionnaires. Sixty percent of the 138 eligible respondents were women, and 22% were self-identified gay/bisexual individuals. Women were more likely than men to report at least 1 form of emotional abuse (odds ratio [OR] = 2.3; p =.02) and unwanted sexual touching (OR = 4.3; p = .0004). Lesbian/bisexual women were significantly more likely to report past suicidal ideation than were heterosexual women (OR = 3.7, p = .03). Gay/bisexual men were more likely to report unwanted sexual touching than were heterosexual men (OR = 5.1, p = .04), but the men did not report significantly higher rates of past suicide ideation or suicide attempts. Sexual orientation and a past history of child sexual, physical, and emotional abuse could be compounding risk factors for suicidal ideation among college students.     

Risk and selection processes between the general and the specialty mental health sectors

This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder.     

An Ethnography of an AIDS Hospice: Toward a Theory of Organizational Pastiche

This article describes everyday life at a hospice that provides terminal, residential care to persons with AIDS. Data were gathered over 12 months of participant observation and a series of formal interviews. The hospice is a nonprofit organization that receives most of its financial support from local community churches and agencies. The philosophy of the hospice is common to its genre—that is, care for dying patients should be holistic, personal, and palliative. The hospice staff largely adheres to this philosophy yet also organizes its everyday activities to meet the practical needs of everyone involved. Some of the more interesting staff practices include the use of touch for healing and communicating, and stress management techniques. The essence of everyday life in the hospice, though, is the relationship between the staff member and the resident. The study identifies three types of relationships—caring, pastoral, and intimate. The conclusion focuses on the value of integrating traditional interactionist ethnography and postmodernist social theory for conducting qualitative research on emerging health care phenomena like the AIDS hospice. The concept of organizational pastiche is offered to interpret the distinctive ways health care organizations specializing in HIV/AIDS care must adapt to the unprecedented cultural and biological features of the epidemic.     

Children's Appraisals of their Experiences in Out-of-Home Care

Few studies have asked children directly about their experiences in out-of-home care. This study uses data collected from 180 nine- to-11-year-old children currently in out-of-home care who were asked about their perceptions and appraisals of out-of-home care. Analysis of variance and chi-square analyses were used to examine whether children's appraisals of their lives following removal from their families of origin differ as a function of age, gender, race/ethnicity, type and severity of maltreatment, length of time in out-of-home care, placement type, attachment to current caregivers, and rating of current caregiver/home. Youth who were sexually and emotionally abused, youth who were satisfied with their current caregivers and placements, and girls were more likely to state that their lives would have been worse had they remained with their families of origin. Youth who were physically abused were more likely to report that their lives would have remained the same. Children living in group care were more likely than those living in family foster care or with kin to report that their lives would have been better had they remained with their families of origin. Differences were not found between children living in family foster care and those living with kin nor did children's appraisals differ based on age, race, ethnicity, length of time in out-of-home care, neglect, or severity of maltreatment.     

Hospice Eligibility and Election: Does Policy Prepare Us to Meet the Need?

A 7-point policy model is used to examine policy on hospice eligibility and election in the United States. Despite the growth of hospice, many eligible patients continue to lack access due to difficulties experienced by providers in discerning 6-month prognoses among chronically ill patients, the inability of patients to elect hospice alongside curative care, and limited reimbursement for hospice providers. Though the landscape of dying has evolved, with more deaths occurring later in life from chronic illness, Medicare hospice eligibility requirements have historically remained the same. Utilization would increase if hospice agencies were able to provide fewer restrictions by including ongoing treatments such as transfusions, intravenous nutrition, or palliative radiation. Hospices would be more likely to enroll critically ill patients who require some ongoing curative measures if Medicare reimbursement rates were higher, and patients would be more likely to seek hospice earlier if Medicare election policies were altered to allow concurrent care. Participation would also be increased by extending hospice eligibility past the traditional prognosis of 6 months. Though expansion in public spending of hospice care has been met with some opposition, current research suggests that potential savings due to decreased costs in acute care is promising.     

Health care proxies: whom do young old adults choose and why?

Dying persons are encouraged to name as durable power of attorney for health care (DPAHC) someone who will thus be empowered to make end-of-life treatment decisions for them in the event that they become incapacitated. We use data from the Wisconsin Longitudinal Study to investigate whether and whom older adults designate as their DPAHC. DPAHC appointments are affected by recent hospitalizations, personal beliefs (including religion, fear of death, and the belief that doctors rather than patients should control health care decisions), and personal experience with the recent painful death of a loved one. The selections of DPAHC designees are generally consistent with the hierarchical compensatory model: Married persons overwhelmingly name their spouses, while unmarried parents appoint their children. Women are more likely than men to rely on children. Parents of one or two children tend to bypass their children for another relative. Unmarried, childless persons show considerable heterogeneity in their choices. We discuss implications of these findings for health care policy and practice.     

Phenomenology in End-of-Life Care: Implications for Philosophy and Clinical Practice

Care of the terminally ill and dying in the hospice setting is a growing practice field for social workers. Support to family, as well as the patient, is implicit in hospice care, adding to the reach and impact of the hospice social worker’s role. As people age and approach the end of life, they may encounter changes in their experience of time, space and of the material world. They often have to redefine the role of hope in their day to day lives. Based on these changing experiences and perceptions, phenomenology, with its focus on a patient’s subjective, lived experience, has implications for end-of-life care. The role of empathy and compassion are also explored in relation to existential experiences of the terminally ill through the lens of phenomenology and Eastern philosophy. To complement the Western biomedical model of care for the dying, insight from Eastern philosophical traditions, which view living and dying on the same continuum, and provide an expanded view of suffering bring comfort and understanding to how living and dying are processed within the phenomenology of patient experience and the hospice model of care. Case vignettes demonstrate social work theory and practice at the intersection of various interrelated phenomena when caring for those facing the end of life.     

The Kids Say Project: Supporting Children to Talk about their Experiences and to Engage in Decision-making

Research and policy calls for hearing the voices of children and youth in out-of-home care and involving them in decisions about their own lives. The “Kids Say” cards were designed to facilitate this engagement, particularly with Indigenous children and youth. A feasibility study explored the extent to which the Kids Say cards were acceptable to young people, and prompted discussion about their lives and what is important to them. The study involved 47 participants, aged 7 to 18 years, from three cultural groups: Aboriginal n?=?20; culturally and linguistically diverse (CALD) n?=?10; non-Indigenous English-speaking n?=?17. The cards were found to be appealing to all three groups, and to facilitate child and youth voice. Findings also did not differ significantly according to gender or age. These preliminary findings indicate the potential value of appropriate practice tools to support children and youth to share their experiences and participate in decision-making.

IMPLICATIONS

• Engaging resources, such as the Kids Say resource, are potentially valuable in supporting practitioners to encourage children and young people to share their experiences and participate in decision-making about their own care and service needs.

• Training in creating safe sharing contexts for children and young people is essential. While emphasis is often given to gathering child voices, there is a need for at least equal emphasis on respectful adult listening.

     

Preservice Teachers and Religion: Serious Gaps in Religious Knowledge and the First Amendment

Recognizing the influence of religion on people's worldview and daily lives, we wondered if elementary and secondary social studies preservice teachers knew enough about religions not only to be culturally responsive in a classroom but also whether they knew enough to teach about these religions within the appropriate curriculum. We used questions from previously tested surveys to ascertain the students’ knowledge about world religions, the First Amendment's religion clauses, and the application of religion in schools. Our findings suggest that preservice teachers’ knowledge about all religions, including their own, and about the First Amendment's intent, is lacking.     

Older lesbians' experiences with home care: Varying levels of disclosure and discrimination

ABSTRACT

There is considerable evidence that lesbian, gay, bisexual and transgender (LGBT) older adults have experienced barriers to health care access and have profound fears about how they will be treated in the long-term care system, but the specific experiences of older lesbians have received less attention. Most older adults needing long-term services and supports (LTSS) prefer to remain at home, and this is true for lesbians as well. This article reports on a national, qualitative study of the experiences of 20 older lesbians (age 65 and older) with home care workers. The experiences of six informal partner caregivers with home care services are also included. Emergent themes regarding level of disclosure, experiences with homophobia, evaluation of care received, and thoughts about ideal LTSS are described. Most study participants did not disclose their sexual orientation to their home care workers. A significant minority experienced homophobia, but nearly all ultimately found workers who provided good care with which they were comfortable. Their visions of ideal LTSS included greater affordability and particular qualities that were important for home care workers to possess, such as competence, caring and acceptance. Practice and policy implications are outlined including careful recruitment, training and supervision of home care workers to foster lesbian-sensitive care, but also improved wages and work conditions in order to maintain a quality home care workforce.     

The effects of life events and interpersonal loss on exercise adherence in older adults

Associations of life events and interpersonal loss with participation in home- and group-based exercise were studied in 97 older adults (64 % women, 70.2 +/- 4.1 years). Life events were assessed with a modified Social Readjustment Rating Scale at baseline and 6 and 12 months. Exercise logs and class-attendance records documented exercise participation. Participants experienced 3.62 +/- 3.56 unique life events over the course of the study, and 28 participants reported an interpersonal loss (5 men, 23 women). Number of life events was negatively associated with home-based exercise participation (p <.05); among women, this association approached significance (p =.06) for class-based exercise. Women who experienced an interpersonal loss had lower class-based participation than those who did not (p =.02), but home-based participation rates were unaffected. Life events, particularly interpersonal loss, appear to have a negative impact on exercise in women, and this effect appears greater for class-based than for home-based exercise.     

Comprehensive College Student Suicide Assessment: Application of the BASIC ID

Whether one knows someone who is thinking of suicide, has attempted suicide, or has completed suicide, nearly all individuals who encounter suicide are affected. The influence and residual affects of suicide are further amplified as the issue reaches across communities such as college or university campuses. College and university staff must improve their response to suicidal ideation with comprehensive assessment and intervention. The authors discuss risk factors and basic screening methods for suicide risk. They present Lazarus' BASIC ID tool (ie, Behavior, Affective Responses, Sensations, Images, Cognitions, Interpersonal Relationships, and Drugs or Biological Influences) as a method for conducting a comprehensive suicide assessment. The authors demonstrate assessment procedures through a case vignette.     

Willingness to participate in organ donation among black Seventh-Day Adventist college students

OBJECTIVE AND PARTICIPANTS: The authors studied a group of black and white Seventh-Day Adventist (SDA) college students (N = 334) to compare the power of religious socialization with racial socialization. METHODS: The authors compared the levels of willingness to donate organs between black and nonblack students in an availability sample. RESULTS: Black SDA college students were significantly more likely than white SDA students or SDA students of other races to perceive racism in the healthcare system and to believe that doctors would not make heroic efforts to save their lives if they knew they were organ donors; they were 66.9% less likely to donate organs than were white SDA students or SDA students of other races. CONCLUSIONS: Despite a common religion with a purposive indoctrination, the racial socialization of black SDA students exerted a stronger influence on willingness to participate in organ donation than did that of white students and students of other races within this religion.