Intensity of Case Management Services

ABSTRACT

In a systematic sample of Florida-licensed clinical social workers (N = 273), this study investigated the correlates of perceived adequacy to work with elders with Alzheimer's disease and other types of dementia. Five predictor variables were identified from a standard regression analysis that account for 35.7% of the model's adjusted variance: (a) employment with elders (Beta = .225, p = .000), (b) years of experience (Beta = -.125, p = .018), (c) attitude toward working with elders with Alzheimer's disease (Beta = .351, p = .000), (d) perceived sufficiency of professional education to work with elders with Alzheimer's disease (Beta = .178, p = .002), and (e) attitude toward the delivery of nonclinical services to elders with Alzheimer's disease (Beta = .192, p = .000). Overall, respondents perceived their abilities to work with elders as slightly less than adequate. Implications are discussed.     

Prevalence of Elder Mistreatment as Reported by Social Workers in a Probability Sample of Adult Day Health Care Clients

ABSTRACT

There are growing numbers of Adult Day Health Care (ADHC) programs providing needed health services to community-dwelling elderly. Therefore, ADHC staff are in an opportune position to identify and to intervene in suspected elder mistreatment (EM) cases. In this paper, prevalence estimates of EM are reported for a probability sample of ADHC clients in New York State, using data provided during a social worker informant interview. The abuse “signs and symptoms” items in the social worker informant interview schedule were divided into two categories: (1) physical indicators and (2) client's behavioral indicators. Physical indicators included unexplained bruises and welts, unexplained burns, unexplained lacerations or abrasions, human bite marks, and frequent injuries that are “accidental” or “unexplained.” Client's behavioral indicators included apprehension, being frightened, and afraid to go home. EM prevalence for all 8 items was 12.3 percent. When “apprehensive” was excluded, the EM prevalence was 3.6 percent in this sample. These findings suggest that ADHC provides a point of contact for the assessment and intervention of EM that might otherwise be overlooked among elders who are often isolated or homebound.     

Broadening the Array of Services: Integrating Legal and Social Work Services for Youth and Families

ABSTRACT

The Community Justice and Legal Assistance Clinic (CJLA) is a unique community-based legal clinic developed through a partnership between a law school and a child and family service agency embedded within a low-income community. This article describes the development of this clinic through a community assessment process; its unique multidisciplinary features; the services provided to clients in three of the agency's service areas; the benefits of the partnership for clients, the social service agency, the participating law students, and the law school; and lessons learned for replication of this type of clinic in other communities.     

Welfare and Welfare to Work in the United States

Summary

Despite social work's historic ambivalence toward income support programs, the policy changes introduced by the TANF welfare to work program demand the profession's attention. Although social workers are not directly responsible for the administration or implementation of the program, many serve TANF clients whose lives have been affected by these changes. Tracing social work's historic but reluctant involvement with income support, this paper urges the profession to respond to the challenges posed by the TANF program in a more systematic way and to contribute more effectively to the wider task of poverty eradication.     

The Program of All-Inclusive Care for the Elderly (PACE)

Summary

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Agency Practices Affecting Social Workers Who Treat Substance-Abusing Clients

Abstract

This study interviewed 115 MSWs with substance abuse training working in general social service agencies to determine if they viewed their settings as facilitating or hindering their work with substance-abusing clients. This study builds on the work of Lightfoot and Orford (1986) who found that social workers were more hindered than helped by their agencies' practices regarding substance-abusing clients.

Results: A majority of workers viewed their agencies as facilitating substance abuse-related work through support from supervisors and administrators, availability of substance abuse training, workers' freedom to choose clients, and opportunities to supervise others on substance abuse-related issues. Supervisor data corroborated these findings. This is a hopeful sign for the profession contrasting with considerable social work literature documenting the profession's historic ambivalence toward substance-abusing clients.     

Survival and change: Social work with angry men

Abstract

This paper discusses the risk elements in encounters with six angry male clients of a social services neighbourhood team. Their preoccupation with basic survival needs produced an identification of the worker with an elusive “stolen object”; this leads to a discussion of how we also felt we had become identified with an image of persecuting parent, rooted in their childhood experience. The key notion of our “struggle” with them is linked to that of “boundary-setting” and the therapeutic value of the characteristic escalation of client/worker conflict is examined. The worker's survival is seen as a confirmation of the client's personal integrity. The process of disengagement is then analysed with particular attention to the material transactions between client and worker that served to mark the end of the engagement. We acknowledge the minimalist nature of our strategy with these men, and attempt to examine outcomes.     

Beginning Practice with Preoperative Male-to-Female Transgender Clients

Abstract

Preoperative male-to-female transgender clients often present with specific and unique psychological and social issues distinct from gay male and lesbian clients. Therapists must be ready to assess and help diagnose these in preparation for work with gender queer clients. Therapists must also be prepared to face and resolve the various counter-transference dynamics inherent in therapeutic relationships with transgendered individuals. This Practice Note focuses on the author's beginning clinical and social case management experience working with two preoperative male-to-female transgender individuals.     

Group Therapy for Survivors of Severe Childhood Abuse: Repairing the Social Contract

ABSTRACT

This article presents a model for conducting time-limited group therapy with adult survivors of severe childhood abuse who are diagnosed with complex post-traumatic and dissociative disorders. While difficult to engage in mixed groups, these clients can succeed in structured, homogeneous groups focused on responsible participation, social connection and symptom management. Group sessions are organized around verbal promises, “social contracts,” that encourage the client's active, attentive engagement. Gentle confrontation of dissociative defenses is integral to the success of each session. Group guidelines, the provision of structure, and common themes are explained, as are the group therapist's complicated countertransference responses to these clients.     

Geriatric Hospitals in India,Today and in the Future

Summary

In a country that shuns hospitalization of the elderly, regarding it as disrespect of those who helped youngsters evolve, Heritage Hospital (HH)is a welcome change, a model and pioneer stand-alone geriatric hospital. With its non-ambulatory services looking after sick elderly, HH is like an extended family of seniors. HH's love and fresh air complement its Meals-on-Wheels program, guided by the nutritionist's healthy food. HH's Volunteer Guild; its Diabetes Club, ever growing with India's dramatic rise in the number of diabetics; its Senior Net Club's Click@50, making elders computer savvy; and Grandparent-Grandchild and Golden and Silver Couple contests celebrated on October 1st, are all widely appreciated, enforcing strong values Indians still share on marriage and family. Heritage brings together 10,000 seniors in Hyderabad, strengthening its motto of Eastern philosophy with its strong emphasis on care for the elderly.     

Older Lesbians and Gays Accessing Health and Aged-Care Services

Abstract

The present paper examines older lesbian and gay people's experiences of and expectations for the delivery of health and aged-care services. In-depth narrative interviews were conducted with older gays and lesbians in the Blue Mountains, west of Sydney (NSW, Australia). Data were analysed by identifying evaluative statements within specific narratives and grouping these statements into themes. Participants reflected on the meaning of their sexual identity and how they would like it to be acknowledged when in contact with health and aged-care service providers. In addition to direct discrimination, participants reported a more indirect form of discrimination in providers’ assumption of heterosexuality among clients and their failure to provide lesbian- or gay friendly services. The findings highlight the need for health and aged-care services to better understand and acknowledge older gay and lesbian people's sexual identities to enable improved access to services in the future.     

The Impact of Hopelessness and Hope on the Social Work Profession

Abstract

Burnout and turnover are detrimental to social service organizations, social service providers and clients. Very often organizational characteristics are part of the cause for burnout. Burnout in a job can lead to hopelessness for social service providers and begin a vicious cycle of continued burnout and increased hopelessness. Knowing the characteristics of hopelessness can help social welfare institutions nurture their employee's level of hope thus impacting the way the social service providers work with their clients.     

The Friends Thou Hast

Abstract

Most studies of male commercial sex workers (CSWs) in Thailand have been framed within a context of HIV risk and have investigated sexual behaviours and HIV knowledge. However, Mann et al. (1992) have identified health and social services and a supportive social environment as equally essential partners in an HIV-preventive triumvirate. This paper is based on extended observation and a series of in-depth interviews with forty-three male CSWs who are both organised (bar workers) and freelance as well as a number of clients (farang and Thai) and bar management. This paper examines the social environment in which male CSWs operate. It considers workplace conditions and support, the personal relationships workers have with parents, friends, clients, other bar workers and management, and how these are influenced by workers' cultural norms. A number of recommendations designed to reduce HIV-infection rates are made.     

Untapped Sources for Recruiting Minority BSW Students

Abstract

Social agencies and social services units currently are experiencing a personnel crisis. Many agency employees who provide direct services to clients lack professional education. Decreasing commitment to traditional social work practice with the most vulnerable populations and increasing interest in psychotherapeutic services may account for the shortage of professionally trained social workers.     

Dealing with Resistance: Working with Involuntary Clients in Community-Based Drug Treatment Programs in China

ABSTRACT

This study explores strategies for dealing with client resistance that are commonly used by a group of selected counsellors who work closely with illicit drug users in the community-based compulsory treatment programs in China. Through semistructured in-depth interviews with 16 counsellors, this study finds that different forms of client resistance were experienced in their day-to-day practice, encompassing passive and active behaviours. Five typical strategies are used by Chinese counsellors in this study to deal with client resistance: showing respect and caring and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination. Considering these strategies can also be seen as general principles for dealing with involuntary clients in other fields of social work services, the findings of this study may have broader impact.

IMPLICATIONS

• Effective ways that can be used by counsellors for reducing illicit drug users’ resistance during treatment include: showing respect and caring, and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination.

• Professional social work training is urgently needed among community-based drug treatment social work practitioners in China, to achieve efficient practices and better outcomes.

     

Assessing Tradition in Chinese Elders Living in a Changing Social Environment

SUMMARY

Social workers are increasingly challenged to provide culturally sensitive services to older immigrants from diverse backgrounds. Assessment tools developed in the elder's own cultural context can maximize appropriate assessment and planning. This article describes the development of a tool for measuring adherence to tradition in Chinese elders. In Chinese tradition, an elder's purpose, meaning, and self-worth are derived, in large part, from their contribution to family, relatives, and the community. Existing measures of filial piety and acculturation do not capture this dimension. Filial piety involves being on the receiving end of care, honor, and obedience from younger generations. Acculturation is the opposite of adherence to tradition. One thousand five-hundred and two Chinese elders in China were asked questions on mutual aid and intergenerational exchange. Factor analysis extracted nine items loading into two factors reflective of traditional exchange. This measure could prove useful in understanding the effect of traditional beliefs upon various psychosocial outcomes.     

Professional stances and personal values in the realm of transnational family reunification with older parents: social work practice in an emerging field

National rules for family reunification take place in an increasingly transnational context. Social workers in Switzerland, whether they work in services for migrants or for elders, are confronted with requests for transnational family reunification with older parents. Such requests, while relatively rare, elicit responses which must be viewed as largely founded on professionals' values and norms regarding the care of elders, family cohabitation, the influence of cultural factors, and examined against a backdrop of increasing suspicion of motives for migration—especially in fields where migration issues have not been at the forefront of professional debate and practice. The militant stance of some services for migrants can thus be contrasted with the relative inexperience of professionals active in social services for elders, who rarely encounter recent migrants. The latter are more likely to reflect their own private—and unexamined—views when advising clients in a field characterised by complexity and instability. The authors interviewed social workers and families in two Swiss cantons. Their results point to ways in which distinct professional cultures could enrich each other and provide social workers with tools to critically analyse their own practice in a very difficult field, the contours of which remain largely unexplored.     

Complementary Practices and Herbal Healing

Abstract

As a means of achieving increased levels of health and Wellness, complementary methods such as alternative approaches and medicinal preparations are being utilized to supplement or replace what has been viewed as traditional health care practice. To promote effective, efficient, and comprehensive helping relationships, social workers need to be cognizant that clients are using these methods and products, and how this use can affect the health care services they receive. This article identifies and discusses some of the basic types of alternative practices, herbal preparations, essential oils, and flower essences; as well as, the problems that can result from inadequate knowledge of the use or misuse of these products. In conclusion, emphasis is placed on increasing social work awareness and education in this area.     

Social Security in Asia and the Pacific

Abstract

In terms of numbers of people, the global challenges facing social security systems are largely Asian. Because of rapid population aging in Asia, while it accounted for 28% of the world's population aged 60 and older in 1985, that percentage will more than double to 58% in 2050. Provident funds are a prominent feature of retirement income systems in the region-Asia and the Pacific contain the majority of the world's countries with provident funds. These programs typically provide lump-sum benefits, and thus, do not provide annuity protection against outliving one's resources. Because of the influence of Confucian philosophy with its emphasis on family responsibility for elders, countries in the region have been relatively slow in developing social security programs. China does not have a social security program for workers who do not work for the government or in government-owned enterprises.     

Women's Spirituality: A Proposed Practice Model

SUMMARY

The values and spirituality of clients are an important area for social workers, counselors, and other mental, health professionals to consider in their work. This article addresses the need for professionals to be sensitive to this aspect of growth and development for all clients. Noting that until recently, religious writings have tended to reflect a male-centered bias and patriarchal values, issues related to women's spirituality are identified, implications for therapeutic interventions are discussed, and a model for understanding and facilitating women's spirituality is proposed.