Enhancing Collaborative Leadership in Palliative Social Work in Oncology

The Institute of Medicine (IOM) Report—Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs—provided recommendations for meeting the palliative care needs of our growing population of older Americans. The IOM report highlights the demand for social work leadership across all aspects of the health care delivery system. Social workers are core interdisciplinary members of the health care team and it is important for them to be well prepared for collaborative leadership roles across health care settings. The ExCEL in Social Work: Excellence in Cancer Education &; Leadership education project was created as a direct response to the 2008 Institute of Medicine. (2008). Cancer care for the whole patient: Meeting psychosocial health needs. Washington, DC: National Academies Press. [Google Scholar] IOM Report. This article highlights a sampling of palliative care projects initiated by outstanding oncology social work participants in the ExCEL program. These projects demonstrate the leadership of social workers in palliative care oncology.     

The Living–Dying Interval in Nursing Home-Based End-of-Life Care: Family Caregivers' Experiences

Guided by concepts from the living–dying interval (Pattison, 1977 Pattison, E. M. 1977. The experience of dying, Englewood Cliffs, NJ: Prentice Hall.  [Google Scholar]) this study sought to explore family members' experiences with a dying nursing home resident. In-depth interviews were conducted with 31 caregivers of residents who had died. Interviews were audiotaped and transcribed. Themes that illuminated families' experiences on the living–dying interval were: an acute medical crisis (trigger events, accumulation of stressors, level of care crisis); the living–dying phase (advance care planning, hospitalization, end-stage decisions); and the terminal phase (beginning of the end, awareness of dying). The results illustrate critical periods for social work intervention with families of dying nursing home residents.     

Stepwise Psychosocial Palliative Care: A New Approach to the Treatment of Posttraumatic Stress Disorder at the End of Life

Although evidence-based therapies for Posttraumatic Stress Disorder (PTSD) exist for physically healthy populations, these often do not adequately address PTSD in dying patients. Particularly because these interventions require 8–16 weekly sessions, and the median stay in U.S. hospices is 17.5 days (National Hospice and Palliative Care Organization [NHPCO], 2015 National Hospice &; Palliative Care Organization (NHPCO). (2015). NHPCO Facts and figures: Hospice care in America. Retrieved from http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_Figures.pdf. [Google Scholar]), there is a potentially serious timing mismatch. Moreover, these treatments may temporarily increase trauma symptoms (Nishith, Resick, &; Griffin, 2002 Nishith, P., Resick, P. A., &; Griffin, M. G. (2002). Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 70, 880–886. doi:10.1037//0022-006x.70.4.880[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), resulting in some patients dying in greater distress than had they not received care. The Stepwise Psychosocial Palliative Care (SPPC) model presented in this article compensates for these difficulties by embracing a palliative care approach to PTSD. Although it utilizes techniques drawn from existing PTSD interventions, these are re-ordered and utilized in a time-responsive, patient-centered manner that takes into account prognosis, fatigue, and logistical concerns. The SPPC approach is further considered with respect to existing social work palliative care competencies (Gwyther et al., 2005 Gwyther, L. P., Altilio, T., Blacker, S., Christ, G., Csikai, E. L., Hooyman, N., … Howe, J. (2005). Social work competencies in palliative and end-of-life care. Journal of Social Work in End-of-Life &; Palliative Care, 1, 87–120. doi:10.1300/j457v01n01_06[Taylor &; Francis Online] , [Google Scholar]) and a case study is used to demonstrate its application.     

Relationship Between Pain and Chronic Illness Among Seriously Ill Older Adults: Expanding Role for Palliative Social Work

Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011 Institute of Medicine . ( 2011 ). Relieving pain in America: A blueprint for transforming prevention, care, education and research . Washington, DC : National Academies Press . [Google Scholar]). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed.     

Workplace Characteristics and Work-to-Family Conflict: Does Caregiving Frequency Matter?

Many workers can expect to provide care to an elder relative at some point during their tenure in the workforce. This study extends previous research by exploring whether caregiving frequency (providing care on a regular, weekly basis vs. intermittently) moderates the relationship between certain workplace characteristics and work-to-family conflict. Utilizing a sample of 465 respondents from the National Study of the Changing Workforce (Families and Work Institute, 2008 Families and Work Institute. (2008). National Study of the Changing Workforce [data file and code book]. https://store.familiesandwork.org (http://https://store.familiesandwork.org)  [Google Scholar]), results indicate that access to workplace flexibility has a stronger effect on reducing work-to-family conflict among intermittent caregivers than among those who provide care regularly.     

HIV and PTSD: A Confirmatory Factor Analysis of the PCL Screening Instrument

ABSTRACT

The findings are reported from a confirmatory factor analysis (CFA) of the posttraumatic screening checklist (PCL) created by Weathers et al. (1993) Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A. and Keane, T. M. 1993. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility, Presented at Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX. [Google Scholar]. One hundred and eighty-six individuals receiving either preventive HIV information or ongoing HIV counseling from community-based AIDS organizations in the New York City area completed the PCL checklist. To identify a model relevant to screening posttraumatic stress disorder (PTSD) within the HIV/AIDS community, six CFAs were conducted. Results indicated that the PTSD scale should include attention to four general areas: a) reexperiencing the traumatic event; b) avoidance of anything associated with the traumatic event; c) a sense of numbing; and d) a hyperarousal state. The CFA produced a more concise model of 12 items, relevant to the HIV community. Future research suggests that the relationships between different components of trauma exposure and different manifestations of PTSD should be examined further.     

Challenges of Dealing with Financial Concerns during Life-Threatening Illness: Perspectives of Health Care Practitioners

ABSTRACT

The costs of serious medical illness and end of life care are often a heavy burden for patients and families (Collins, Stepanczuk, Williams, & Rich, 2016 Collins, A., Stepanczuk, C., Williams, N., & Rich, E. (2016). Supporting better patient decisions at the point of care: What payers and delivery systems can do (Mathematica Policy Research Issue Brief). Retrieved from http://econpapers.repec.org/paper/mprmprres/6c6a86e28d7149c993713352eeceaa18.htm [Google Scholar]; Kim, 2007 Kim, P. (2007). Cost of cancer care: The patient perspective. Journal of Clinical Oncology, 25(2), 228–232. doi:10.1200/JCO.2006.07.9111[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; May et al., 2014 May, C. R., Eton, D. T., Boehmer, K., Gallacher, K., Hunt, K., MacDonald, S.,?… &?Rogers, A. E. (2014). Rethinking the patient: Using burden of treatment theory to understand the changing dynamics of illness. BMC health services research, 14(1), 1–11. doi:10.1186/1472-6963-14-281[Crossref], [PubMed] , [Google Scholar]; Zarit, 2004 Zarit, S. H. (2004). Family care and burden at the end of life. Canadian Medical Association Journal, 170(12), 1811–1812. doi:10.1503/cmaj.1040196[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Twenty-six practitioners, including social workers, managers/administrators, supervisors, and case managers from five health care settings, participated in qualitative semistructured interviews about financial challenges patients encountered. Seven practitioners took part in a focus group. Practitioners were recruited from hospice (n?=?5), long-term care (n?=?5), intensive care (n?=?5), dialysis (n?=?6), and oncology (n?=?5). Interview and focus group questions focused on financial challenges patients encountered when facing life-threatening illness. Interview data were transcribed and thematically coded and trustworthiness of data was established with peer debriefing, member checking, and agreement on themes among the authors. Practitioners described interacting micro, meso, and macroinfluences on the financial well-being and challenges patients encountered. Microlevel influences involved patient characteristics, such as their demographic profile and/or health status that set them up for financial aptitude or challenges. Macrolevel influences involved the larger health care/safety net system, which provided valuable resources for some patients but not others. Practitioners also discussed the mesolevel of influence, the local setting where they worked to match available resources with patients’ individual needs given the constraints emerging from the micro and macrolevels. Practitioners described how they navigated the interplay of these three areas to meet patients’ needs and cope with financial challenges. Implications for practice point to directly addressing the kind of financial concerns that patients and families facing financial burden from serious medical illness have, and identifying ways to bridge knowledge and resource access gaps at the individual, organizational, and societal levels.     

Fostering Integrity in Postgraduate Research: An Evidence-Based Policy and Support Framework

Postgraduate research students have a unique position in the debate on integrity in research as students and novice researchers. To assess how far policies for integrity in postgraduate research meet the needs of students as “research trainees,” we reviewed online policies for integrity in postgraduate research at nine particular Australian universities against the Australian Code for Responsible Conduct of Research (the Code) and the five core elements of exemplary academic integrity policy identified by Bretag et al. (2011 Bretag, T., Mahmud, S., Wallace, M., Walker, R., Green, M., East, J., James, C., McGowan, U. and Partridge, L. 2011. Core elements of exemplary academic integrity policy in Australian higher education. International Journal for Educational Integrity, 7: 3–12.  [Google Scholar]), i.e., access, approach, responsibility, detail, and support. We found inconsistency with the Code in the definition of research misconduct and a lack of adequate detail and support. Based on our analysis, previous research, and the literature, we propose a framework for policy and support for postgraduate research that encompasses a consistent and educative approach to integrity maintained across the university at all levels of scholarship and for all stakeholders.     

An Exploration of Mental Health Literacy Among African American Clergy

ABSTRACT

The purpose of this qualitative study was to explore African American clergy's mental health literacy with older congregants 60 years of age and older. Using a grounded theory approach, we recruited a purposive sample of 9 African American clergy representing diverse ages, denominations, locales, and educational levels. Data was coded and classified according to Kevin's (1976) Kevin, R. C. 1976. Factors influencing the judgment and referral of mental health presenting problems by clergymen and psychologists, Unpublished doctoral dissertation: University of Texas, Austin.  [Google Scholar] typology of pastoral counseling and Jorm et al.'s (1997) Jorm, A. F., Korten, A. E., Jacomb, P. A., Christensen, H., Rodgers, B. and Pollitt, P. 1997. “Mental health literacy”: A survey of the public's ability to recognize mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166: 182–186. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] conceptual model of mental health literacy. Findings from data analysis revealed study respondents were adherents of Kevin's Religious–Community (R–C) model. Additionally, the following themes emerged: loss of cognitive functioning, psychosocial stressors, religiosity, and appreciation for professional assistance, cultural barriers, and key informants/familiarity with formal mental health providers which partially maps onto Jorm et al.'s conceptual model of mental health literacy.     

Evaluating research misconduct policies at major research universities: A pilot study

This pilot study evaluates the accessibility and usefulness of the research misconduct (RM) policies at the top-25 universities as ranked by NIH and NSF grant awards. Measuring accessibility demonstrates how readily-available policies are to the people they affect. Evaluating the range of policy content indicates whether policies and procedures on research misconduct are “useful” as opposed to merely “minimal” (Rhoades, 2003 Rhoades, L. J. Policies and Procedures: Minimal or Useful. Presentation to the introductory workshop for institutional research integrity officers. University of Connecticut Health Center.  [Google Scholar]). On average, it took five clicks to get from a university's home page to its RM policies. Only nine policies were accessed within three or fewer clicks. Policy information was coded into categories comprising a total of 20 topic areas, which were then grouped into five content domains. The policies reveal a broad range of usefulness. Some provide relevant details on almost every topic area, while others leave most questions unanswered. Three of the 20 topic areas are almost universally covered in the policies analyzed. In contrast, five other topic areas average less than half of the information which could have been included. These policies, from elite U.S. research universities, may serve as role models; as such they should perhaps be held to the highest standards. If the message sent by a policy lacks clarity and precision, it should be revised to include an appropriate level of detail.     

Grief and Trauma Group Therapy for Children After Hurricane Katrina

Theoretical and evidence-based group therapy models that address the interplay of grief and trauma are needed for children postdisaster. This article describes a theoretically informed 10-week grief and trauma group model that was evaluated with children in schools after Hurricane Katrina. The foundation of the grief and trauma intervention includes utilizing developmentally specific methods, an ecological perspective, and culturally relevant approaches. The theoretical ordering of themes addressed occurs within three overlapping phases: (1) resilience and safety, (2) restorative retelling, (3) and reconnecting (Herman, 1997 Herman, J. L. 1997. Trauma and recovery, New York: Basic Books.  [Google Scholar]; Rynearson, 2001 Rynearson, R. 2001. Retelling violent death, Philadelphia: Brunner-Routledge.  [Google Scholar]). Techniques from cognitive behavioral therapy and narrative therapy are combined to address loss and trauma.     

Mixed-Status Families and Immigration Interior Enforcement Policies: Effects on Clinical Practice and the Intraethnic Therapeutic Dyad

ABSTRACT

This article explores the sociopolitical and intersubjective enactments that unfolded when working with a mixed-status immigrant family facing parental deportation. Through the integration of a sociopolitical and intersubjective conceptualization, dynamics pertaining to inclusion, exclusion, domination, and subjugation are examined. The psychological exploration of the clinical treatment is guided by Altman’s (2010 Altman, N. (2010). The analyst in the inner city: Race, class and culture through a psychoanalytic lens (2nd ed.). New York, NY: Routledge. [Google Scholar]) three-person psychology and Stolorow’s (1991 Stolorow, R. D. (1991). The intersubjective context of intrapsychic experience: A decade of psychoanalytic inquiry. Psychoanalytic Inquiry, 11, 171–184. doi:10.1080/07351699109533850[Taylor & Francis Online], [Web of Science ®] , [Google Scholar], 1993 Stolorow, R. D. (1993). Chapter 3 thoughts on the nature and therapeutic action of psychoanalytic interpretation. Progress in Self-Psychology, 9, 31–43. [Google Scholar]) theory of intersubjectivity. The analysis also incorporates dynamics pertaining to the ethnocultural transference and countertranference (Comas-Díaz & Jacobsen, 1991 Comas-Díaz, L., & Jacobsen, F. M. (1991). Ethnocultural transference and countertransference in the therapeutic dyad. American Journal of Orthopsychiatry, 61(3), 392–402. doi:10.1037/h0079267[Crossref], [PubMed], [Web of Science ®] , [Google Scholar], 1995 Comas-Díaz, L., & Jacobsen, F. M. (1995). The therapist of color and the white patient dyad: Contradictions and recognitions. Cultural Diversity and Mental Health, 1(2), 93–106. doi:10.1037/1099-9809.1.2.93[Crossref], [PubMed] , [Google Scholar]) and to associative identification processes (Shonfeld-Ringer, 2000 Shonfeld-Ringer, S. (2000). Close encounters: Exclusion and marginalization as an intersubjective experience. Smith College Studies in Social Work, 71(1), 51–59.[Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). The case illustrates how dynamics of racialization, embedded within an increasingly White Nativist, ideological deportation immigration context, infiltrated the intraethnic, therapeutic relational encounter. The therapist took part in an intragroup, racialized reenactment that could have led to the therapist becoming part of the oppressive structure, but the therapist avoided doing so, explaining her internal process for rectifying the situation.     

Enhancing Forgiveness: A Group Intervention for the Elderly

This article describes a therapeutic model of forgiveness (Enright, 2001 Enright, R. D. 2001. Forgiveness is a choice: A step-by-step process for resolving anger and restoring hope, Washington, D.C: American Psychological Association.  [Google Scholar]) and discusses its applicability to social work intervention with older adults. A total of 20 men and women, aged 57–82, participated in 2 different forgiveness groups, each of which met weekly for 8 sessions with a 4-month follow-up session. Measures of forgiveness, as well as biopsychosocial functioning, were collected before and after the group intervention. Results indicated that participants experienced long-term improvement with respect to forgiveness and depression, short-term improvement of physical health, and no change in relation to anxiety or social support. Clinical issues that emerged during the forgiveness group are discussed, and suggestions for gerontological social workers are offered.     

Academic Affiliations of Social Work Journal Article Authors from 1999–2003: A Productivity Analysis from the United Kingdom

ABSTRACT

Following the protocols established by Ligon, Jackson, and Thyer (2007), author affiliations of 639 articles published in five UK social work journals between 1999 and 2003 were tabulated to generate a ranking of universities. Seventy-three universities published three or more articles. The findings are discussed in relation to the earlier article by Ligon et al. (2007) Ligon, J., Jackson, D. L. and Thyer, B. 2007. Academic affiliations of social work journal article authors from 1993–2003: A productivity analysis spanning 25 years of social work scholarship. Journal of Social Service Research, 33(2): 13–20. [Taylor & Francis Online] , [Google Scholar]. It is argued that a globalized approach to the analysis of the productivity of social work academics should be developed. A first step might be the integration of the U.S. and UK productivity analysis for relevant years.     

Open-Ended and Open-Door Treatment Groups for Young People with Mental Illness

The concept of open-ended groups is expanded to include an open-door model (OEOD) wherein members with severe mental illnesses, including schizophrenia disorders and bipolar, can join, leave, and reenter groups as their life circumstances dictate their availability and willingness for treatment. This model is grounded on the work of Schopler and Galinsky's (1984/2006 Schopler, J. H. and Galinsky, M. J. 2006. Meeting practice needs: Conceptualizing the open-ended group. Social Work with Groups, 28(3): 49–68. (Original work published 1984) [Google Scholar]) and Galinsky and Schopler's (1989 Galinsky, M. and Schopler, J. 1989. Developmental patterns in open-ended groups. Social Work with Groups, 12(2): 99–114. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) theses on the value and processes of open-ended groups and includes perspectives on mutual aid and group development. Groupwork with the OEOD format is illustrated with examples taken from a group of 79 participants diagnosed with first-episode schizophrenia/schizoaffective disorders, 40 of whom had cooccurring substance abuse. Of the 79 participants in the OEOD group program, 70 (89%) remained in treatment for the maximum of 3 years. The overall value of group treatment for this population is reviewed along with the small number of available publications on open-ended and open-door type groups.     

The Psychotherapeutic Dimensions of Clinical Case Management with a Combat Veteran

This article addresses the overlapping dimensions of clinical case management and psychotherapy. The theoretical framework that is used as the basis of analysis is drawn from the work of D. W. and Clare Winnicott. Kanter has more than adequately demonstrated that these two authors were extremely knowledgeable about clinical case management and psychotherapy. The conclusion of the paper agrees with D. W. Winnicott (1961 Winnicott, D. W. 1961. “Varieties of psychotherapy.”. In Home is where we start from: Essays by a psychoanalyst, Edited by: Winnicott, C, Shepherd, R and Davis, M. 101–111. New York: Norton.  [Google Scholar]) who defined clinical case management as a variety of psychotherapy. The shared psychotherapeutic dimensions of clinical case management are identified as a focus on human development, the importance of the facilitating/holding environment and issues related to transference and countertransference.     

Self-Reported Ageism in Social Work Practitioners and Students

In this study, we focus on self-reported ageism in college students and social service providers using the Relating to Older People Evaluation (ROPE; Cherry & Palmore, 2008 Cherry, K. E. and Palmore, E. B. 2008. Relating to Older People Evaluation (ROPE): A measure of self–reported ageism. Educational Gerontology, 34: 849–861. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]). The ROPE is a 20-item questionnaire that measures positive and negative ageist behaviors that people engage in during everyday life. Participants included undergraduate and graduate social work students and practicing social service providers in the nursing home and mental health setting. Findings indicate that people of varying educational backgrounds and occupational experience in social services readily admit to positive ageist behaviors. Item analyses revealed similarities and differences between groups in the most and least frequent forms of ageism endorsed. Ageism as a social phenomenon with implications related to social work policy and practice is discussed.     

Social Workers,Intimate Partner Violence (IPV), and Client Financial Concerns

ABSTRACT

The negative impact of financial abuse on intimate partner violence (IPV) survivors is well researched (Babcock, Waltz, Jacobson, & Gottman, 1993 Babcock, J. C., Waltz, J., Jacobson, N. S., & Gottman, J. M. (1993). Power and violence: The relation between communication patterns, power discrepancies, and domestic violence. Journal of Consulting and Clinical Psychology, 61(1), 40–50. doi:10.1037/0022-006X.61.1.40[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), however literature indicating how often social workers ask clients about financial concerns is currently limited. This study examined the frequency with which social workers asked clients about their financial concerns and how that relates to perceived knowledge of IPV and perceived preparedness to work with clients experiencing IPV. A total of 266 social workers who were alumni of a university located on the eastern shore of the United States responded to the questionnaire. Fewer than 30% of respondents reported that they always asked clients about their financial concerns. Logistic regression was used to model the association of always asking clients about financial concerns as a function of perceived knowledge (model 1) and perceived preparedness (model 2). In model 1, perceived knowledge, IPV education and/or training, and age were significant predictors of always asking about financial concerns (p < .05), while in model 2, perceived preparedness and age were significant predictors (p < .05). More research is needed to explore social workers' comfort with addressing client financial concerns and implications for practice.     

What Anonymous can tell us about the relationship between virtual community structure and participatory form

As a decentralised virtual community, Anonymous has been characterised by its oppositional tendencies. Helped by a collective persona and horizontal management structure, Anonymous has facilitated a myriad of differentiated agenda. However, we can observe a distinct change in its participatory form over time. So, while Anonymous, more broadly, functions as a virtual community, its means of engagement has shifted from a social movement to a decentralised cell network. This article explores the relationship between these changes, and its evolution as a virtual community. Drawing upon Iriberri and Leroy’s [(2009 Iriberri, A., and G. Leroy. 2009. “A Life-Cycle Perspective on Online Community Success.” ACM Computing Surveys (CSUR) 41 (2): 1–29. doi: 10.1145/1459352.1459356[Crossref], [Web of Science ®] , [Google Scholar]) “A Life-Cycle Perspective on Online Community Success.” ACM Computing Surveys (CSUR) 41 (2): 1–29] life cycle framework, the article maps Anonymous’ development and identifies the structural changes that have led to this transformation in its modes of participation.