Analysis and Treatment of Self-Neglectful Behaviors in Three Elderly Female Patients

ABSTRACT

Three cases of self-neglect in elderly female patients are presented. Ranging in age from 84 to 92, subjects suffered from chronic, non-terminal illnesses, and engaged in such behaviors as refusal to eat, non-adherence to a prescribed therapeutic regimen, and extreme social withdrawal. One lived in the community and two resided in assisted living facilities in Louisville, Kentucky. Initial interviews strongly suggested that the patients' engagement in self-neglect was an inappropriate yet purposeful response to aversive events or other negative stimuli. Goals of treatment were to (1) identify specific factors which precipitated patient use of potentially life-threatening behavior, and (2) employ behavioral methods of intervention in response to the identified precipitators. Outcomes were moderately positive. Behavioral interventions reduced engagement in self-neglectful behaviors for each of the participants to a clinically significant degree. Positive results were maintained during the three-month period following treatment termination.     

The Significance of Community to Business Social Responsibility1

Abstract In this paper, I focus attention on one aspect of business social responsibility, the relationship between businesses and community. Specifically, I explore the impact of business operators' perceptions about norms of collective action in their communities on the level of their support for and commitment to their communities. This relationship was elaborated using data from interviews with 1,008 business owners and managers randomly selected from 30 small Iowa communities (500 to 10,000 in population). Findings indicate the majority of small business operators report that they are committed to and provide support for their community. Also, it is concluded that operators' educational levels and lengths of residence, the success and age of their businesses, and their perceptions of community levels of collective action are significantly associated with levels of business social responsibility.     

Organizational Responsibility for Age-Friendly Social Participation: Views of Australian Rural Community Stakeholders

This qualitative study critically explores the barriers experienced by diverse rural community stakeholders in facilitating environments that enable age-friendly social participation. Twenty-six semi-structured interviews were conducted across two rural Australian communities with stakeholders from local government, health, social care, and community organizations. Findings identify that rural community stakeholders face significant difficulties in securing resources for groups and activities catering to older adults, which subsequently impacts their capacity to undertake outreach to older adults. However, in discussing these issues, questions were raised in relation to whose responsibility it is to provide resources for community groups and organizations providing social initiatives and whose responsibility it is to engage isolated seniors. These findings provide a much-needed critical perspective on current age-friendly research by acknowledging the responsibilities of various macro-level social structures—different community-level organizations, local government, and policy in fostering environments to enable participation of diverse rural older adults.     

Spirituality and the Gay Latino Client

An essential element in providing social services to clients form diverse communities is an understanding of cultural norms and values. The importance of acknowledging the understanding the role of spiritual beliefs and practices in working with gay Latinos is paramount when one considers the strong influence that organized religion and alternate belief systems have had on the societal, cultural and familial lives of these clients. This article looks at the role of spirituality in working with gay Latino clients, and offers suggestions for enhanced service delivery.     

Barriers and Facilitators to Implementing Functional Family Therapy in a Community Setting: Client and Practitioner Perspectives

While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre‐intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in ‘real‐world’ settings.     

Financial Sustainability Within UK Charities: Community Sport Trusts and Corporate Social Responsibility Partnerships

The change in political leadership in the UK in 2010 has created financial uncertainty and instability for many third sector organisations. In a shifting funding landscape, it is clear that an over-reliance on Government funding is a risky strategy and that there is a need to diversify and seek out alternative sources of revenue. This article considers the impact of political change on the financial sustainability of community sports trusts associated with Premier League and Football League clubs in England. It explores sources of revenue through the analysis of financial statements, revealing that on average community sports trusts receive a significant proportion of income from grant funding whilst sponsorship income is relatively small. The article goes on to discuss the potential for community sports trusts to diversify revenue streams by developing social partnerships that address the corporate social responsibility (CSR) agendas of commercial organisations. It illustrates that although commercial sponsorship can provide benefits including the provision of additional funding that can enable financial stability, key issues include the balance of power, the impact on organisational flexibility, whether there is a need to restructure, and the development of long-term partnerships. Although the findings from this article are focused on a particular type of charity, given the importance of CSR partnership income for the charities sector they may also have broader implications for other charitable organisations.     

Client retention in residential drug treatment for Latinos

Client drop out from treatment is of great concern to the substance abuse field. Completion rates across modalities vary from low to moderate, not ideal since length of stay has been positively and consistently associated with better client outcomes. The study explored whether client characteristics shown to be related to retention were associated with treatment completion and treatment duration for a sample of 164 Latino substance users who entered a culturally focused residential program. In-person client interviews were conducted within a week of program admission. Logistic regression analysis was used to examine research questions. Clients most likely to drop out had self-reported co-occurring psychiatric diagnoses; they were 81% less likely to complete the program, suggesting that clients with mental health problems have a more difficult time remaining in residential treatment. Clients using drugs in the three months prior to entry were three and a half times more likely to be in the shorter stay group, and clients who lived in institutions prior to program entry were three times more likely to be in the longer-stay group. Factors contributing to drop out for this Latino sample were similar to those identified in the literature for non-Latino samples. Methods for addressing the needs of clients with co-occurring disorders are discussed.     

The Child Client

In court cases involving children the child is often a party to proceedings and is thus entitled to Legal Aid and representation by a solicitor. This representation of the child happens not just in youth courts under the Criminal Justice Act 1991 but also in Family Courts in proceedings under the Children Act 1989. This article looks at how a solicitor ascertains whether a child client is competent to give instructions and offers information on the techniques employed by the solicitor in communicating with the child, especially in proceedings under the Children Act.     

Responsibility for examining an asylum

Parallel to the influx of asylum seekers during the 1980s, xenophobic tendencies have been witnessed in certain Western European countries. While directed at all foreigners, these tendencies sometimes have led to restrictive practices or methods which include both denying that asylum seekers qualify as refugees, so they may be sent home more easily, and shifting the responsibility for examining asylum claims to other countries. An analysis of the increasingly restrictive practices regarding the granting of asylum and the concept of a refugee is a complicated task, which requires a detailed investigation of the jurisprudence in a number of countries. This article, however, will not concentrate on an analysis of jurisprudence regarding asylum but rather on the tendency of various states to shift the responsibility for examining asylum requests to another country.     

Staying With The Client

Abstract

Since the early seventies there have been widespread assumptions in social work that: (a) effective therapy is necessarily brief-lasting, at most, eight to ten sessions, and (b) that we should only deal with the problems that the client wants help with.

The author challenges the universality of these assumptions, and their basis in research and considerations about supposed cost-effectiveness. He illustrates through a single case study of a depressed adolescent girl and her unhappy mother that although contact could have been terminated after ten sessions, when the identified patient was better, in fact it would probably have achieved very little, since intervention up to that point had had the effect of making the mother only too painfully aware of her life predicament and reducing her almost to despair.

At the mother's request, social work contact continued for a further eleven sessions, spread over five months. She appeared to use this to achieve a considerable degree of acceptance of her painful and deprived childhood, and adopt a very much more positive attitude to her future. Her depression lifted, and her anxiety diminished. Follow-up eighteen months later strongly suggested that the gains made had been maintained for both mother and daughter.     

The HMO Client:

No abstract available for this article.     

Client Disclosure of Lesbianism:

Three hundred lesbian women were recruited through a snowball design survey. Discriminant analysis was used to differntiate those who disclosed their sexual orientation to their health care provider from those who did not. Disclosers had a greater number of friends to whom they disclosed, were less likely to currently drink alcoholic beverages, were more likely to have obtained a physical examination in Alaska in the previous five years, were older, and had seen more mental health counselors than nondisclosers. The model accounted for 20.91 percent of the variance in disclosure to health care providers. A majority of the respondents who disclosed (65.32%#37;) reported no perceived difference in health care provided following disclosure of sexual orientation.     

BPD and the Need for Community

SUMMARY

This chapter emphasizes the importance of a community/systems approach in managing the treatment of individuals with borderline personality disorder. The natural systems existing around patient, clinician and family are recognized, and we examine how working teams are built from these systems. The Borderline Center at McLean Hospital is used as an illustration of an organizational model that utilizes the concept of the “holding environment” (Winnicott, 1965) to provide comprehensive services to borderline patients and their families. As patients move through various levels of care and exhibit typical borderline symptomatology, the importance of communication and coordination on the part of the treatment team is highlighted. This chapter also will illustrate the essential ways in which patients, clinicians and families are able to join together in the treatment of this disorder, with special emphasis on the necessity of family involvement. We also will examine how the treatment teams provide the foundation for larger communities, which are critical to sustaining the ongoing work of its members.     

Community responsibility for the self-neglectful client

Self-neglectful clients, including the elderly, are in jeopardy, partly through their refusal to accept community services that could help them; they require protection from the community. These people are alienated and isolated, and need to be integrated into the community. Their individual rights to control their own lives, however, must be protected. It is the responsibility of the community to structure services in a way that will engage these people. A comprehensive community service program appropriate to their needs would integrate formal and informal care systems by interweaving professional services, informal assistance, and mutual aid within structures that facilitate coordination of formal care programs.