FEMALE CAREGIVERS’ REFLECTIONS ON ETHICAL DECISION-MAKING: THE INTERSECTION OF DOMESTIC VIOLENCE AND ELDER CARE

As our population ages, increasing numbers of social workers and other therapists will provide counseling to women who are caregivers of frail elders. These female caregivers often face complex ethical dilemmas in caring for a frail elder. Furthermore, these dilemmas are compounded by domestic violence in the caregiver/frail elder relationship initiated before the onset of caregiving. Illustrated with case examples, this article presents an ethical decision-making model based on an empowerment framework for helping practitioners work with caregivers who face difficult dilemmas impacted by domestic violence. Implications for strengthening clinical practice with these caregivers are discussed.     

Jenseits des S?kularisierungsparadigmas?

Charles Taylor??s book A Secular Age is a widely appraised alternative to the classical paradigm of secularization theory. This article situates this alternative theory within the debate of sociology of religion on secularization and its sub-components. Three requirements are formulated that alternative conceptions would have to met. First, they need to understand why ?secularity?? became such a prominent category of self interpretation in modern societies. Second, they have to be able to integrate years of cumulative sociological research on sub-processes of secularization with findings on genuinely modern forms of religious vitality emphasized by the classical paradigm??s critics. And in light of on-going debates over multiple modernities, they would need to describe and explain the varieties of differentiation in societal and cultural comparison. In critical discussion of Charles Taylor??s contribution, the limits of culturalist theories of modern secularity as well as some tasks for historical-sociological research on religion in modernity are identified.     

Perceived benefits of VFW post participation for older adults

Older adults, as active members of the Veterans of Foreign Wars (VFW), describe multiple benefits of participation in the organization to their overall well-being. This qualitative study examined the perspectives of 20 active participants of a VFW Post and its Ladies Auxiliary. Findings indicate that, for the study participants, the VFW serves as a primary source of cross-generational influence, emotional support, and meaningful activity and provides a safe and secure environment for members. This article provides valuable information that social work researchers and practitioners can use to help increase older adults' civic engagement and address service gaps.     

Caregivers' use of spirituality in ethical decision-making

This qualitative study examined ethical dilemmas faced by female caregivers of frail elders as well as the dominant role of caregivers' spirituality in addressing these dilemmas. Dilemmas are difficult decisions that involve conflicting values, e.g., freedom versus safety. In-depth interviews were conducted with thirteen ethnically diverse caregivers recruited from a home health agency and its parent hospital. Purposive sampling was used to obtain variation among research participants. Focus group interviews of home health staff, key informant caregivers, and interviewees provided guidance for the research design, reflection on findings and development of implications. In order to deal with ethical dilemmas, all caregivers used spirituality as (1) a philosophy of life, e.g., "This is what you do when you're family," (2) an aid to decision-making, e.g., through the use of prayer; and/or, (3) a way to transcend dilemmas, e.g., "no choice is hard." Implications include the importance of caregiver-driven assessment, professional self-reflection, and sustained formal services for caregivers.     

Bridges and Barriers: Religion and Immigrant Occupational Attainment across Integration Contexts

This article advances knowledge about context‐dependent impacts of religion on immigrant structural integration. Drawing on theories of inter‐generational immigrant integration, it identifies and spells out two context‐dependent mechanisms through which religion impinges upon structural integration – as ethnic marker prompting exclusion and discrimination, or as social organization providing access to tangible resources. The propositions are empirically tested with nationally representative data on occupational attainment in three different integration contexts which vary in religious boundary configurations and religious field characteristics – the United States, Canada, and Western Europe. Using data from the US General Social Survey, the Canadian Ethnic Diversity Survey, and the European Social Survey, the article analyzes indirect and direct effects of religious affiliation and participation on occupational attainment among first and second generation immigrants. The analyses find only limited evidence for the assumption that in contexts with strong religious boundaries (such as Western Europe and, to a lesser extent, Canada), immigrants face religious penalties in structural integration. By contrast, the analyses support the assumption that in contexts with a thriving religious field (such as the United States and, to a lesser extent, Canada), religious attendance tends to be positively related to occupational attainment, especially for the second generation. For the first time, the article empirically tests arguments about transatlantic differences in the role of religion for immigrant structural integration, and it suggests ways of better integrating micro‐oriented survey research with macro‐oriented institutional analysis.     

An Examination of the Adult Day Services Industry Using the Resource Dependence Model within a Values Context

The adult day services (ADS) industry continues to grow and develop in providing care to larger numbers of older adults and their caregivers. Despite the growth in the number of programs and the changes in the way services are delivered, a systematic examination of the development of the ADS industry from a policy perspective has not been published since the mid-1990s. This article provides an analysis of the development of the ADS industry using the resource dependence model within a values-based context to determine whether public reimbursement opportunities are congruent with the needs of older adults and caregivers. Potential directions for the future development of the industry are presented through analysis of the collaborations of adult day providers with the providers of other services for older adults and the effort by public and private funders to connect quality outcomes and resources.     

The Role of the Gerontological Social Worker in Assisted Living

This qualitative study reports on thirteen assisted living (AL) administrators' perspectives of the role and the importance of the AL social worker in addressing the unmet needs of older adults as they move and transition into AL. Participant interviews were analyzed using the constant comparative method. Administrators described 5 AL social work roles: (a) decision-making and adjustment coordinator; (b) resident advocate; (c) mental health assessor and counselor; (d) family social worker; and (e) care planner. Implications include directly examining AL social workers' views, analyzing costs and benefits of employing AL social workers, and developing social work practicum sites within AL.     

Health Interventions and Health Equity: The Example of Measles Vaccination in Bangladesh

Although the existence of socioeconomic differentials in infant and childhood mortality in developing countries is well established. little consensus exists as to the most effective approaches to reducing such differentials. This article utilizes longitudinal data from the Matlab study area in rural Bangladesh to investigate the impact of an efficacious child survival intervention—measles vaccination—on reductions in gender and socioeconomic differentials in childhood mortality. The article analyzes data from 16,270 vaccinated children and randomly matched controls, and evaluates their subsequent mortality risks. Proportional hazards analysis demonstrates that unvaccinated children from very poor families face more than a threefold higher risk of subsequent early child mortality, compared to vaccinated children from families of high economic status. While measles vaccination has little impact on mortality risks among children of higher economic status, the improvement in survival among children from poorer households is pronounced. The provision of measles vaccination markedly reduces mortality risks for poorer children—from over three times higher to just over 1.5 times higher relative to vaccinated children from wealthier families. The findings of this study are evaluated in terms of the potential of child survival interventions such as measles vaccination to promote greater health equity.     

Telling the Story of Stepfamily Beginnings: The Relationship between Young-adult Stepchildren's Stepfamily Origin Stories and their Satisfaction with the Stepfamily

The current study adopts a narrative perspective in examining the content of 80 stepchildren's stepfamily origin stories. Results reveal five types of stepfamily origin stories: Sudden, Dark-sided, Ambivalent, Idealized, and Incremental. Results support the hypothesis that story type would predict differences in family satisfaction; stepchildren who described their stepfamily origins as Idealized were more satisfied than those whose origins were Dark-sided or Sudden. Overall, participants framed their stepfamily identity more positively when their stepfamily beginnings were characterized by closeness, friendship, and even expected ups and downs, rather than when they were left out of the process of negotiating or forming the stepfamily and when the beginnings were tainted by issues they considered to be dark. Stepparents or practitioners may benefit from these findings by examining the means by which stepparents may involve stepchildren in the process of stepfamily courtship, facilitate closeness, and set up realistic expectations for negotiating stepfamily life.     

Clinical Results Using Virtual Reality

Abstract

Virtual Reality (VR) technology offers new opportunities for the development of innovative clinical research, assessment, and intervention tools. VR-based testing, training, teaching, and treatment approaches that would be difficult, if not impossible to deliver using traditional methods are now being developed that take advantage of the assets that are available with VR technology. As research evidence continues to indicate clinical efficacy, VR applications are being increasingly regarded as providing innovative options for targeting the cognitive, psychological, motor, and functional impairments that result from various clinical health conditions. VR allows for the precise presentation and control of stimuli within dynamic multisensory 3-D computer generated simulations as well as providing advanced methods for capturing and quantifying behavioral responses. These characteristics support the rationale for the use of VR applications in clinical assessment, intervention, and training. This article begins with a brief review of the history and rationale for the use of VR with clinical populations. We then detail one use-case for the clinical application of VR—the exposure therapy treatment of anxiety disorders and post-traumatic stress disorder. While significant work is cited in other areas of Clinical VR (e.g., pain management, cognitive/physical assessment/rehabilitation, eating disorders, social skills/clinical training, etc.), a full overview of such a broad literature is beyond the scope of this article. Thus, we have opted to provide more in-depth analysis of one specific clinical area that clearly illustrates how VR has been successfully applied and is supported by an encouraging and evolving scientific literature.