Project LIFE: a partnership to increase physical activity in elders with multiple chronic illnesses

The authors describe a medical center-based randomized trial aimed at determining the feasibility and effectiveness of partnering patients and primary-care providers with an exercise health counselor. Study participants included 165 veterans age 70 years and older. The primary end point was change in physical activity at 3 and 6 months comparing patients receiving high-intensity physical activity counseling, attention control counseling, and usual care after receiving standardized clinic-based counseling. We noted a significant Group x Time interaction (p = .041) for physical activity frequency and a similar effect for caloric expenditure (p = .054). Participants receiving high-intensity counseling and usual care increased physical activity over the short term, but those with usual care returned to baseline by the end of the study. The intervention was well received by practitioners and patients. We conclude that partnering primary-care providers with specialized exercise counselors for age- and health-appropriate physical activity counseling is effective.     

Race,Gender, and Social Support: A Study of Networks in a Financial Services Organization

A wealth of research indicates that social support improves employees' well-being and job performance. What is not well understood is how employees' race and gender influence the receipt of this type of support. I analyze qualitative and quantitative data to understand how race and gender influence the social support that workers receive. The results suggest that neither structural nor relational factors explain why blacks receive social support from fewer network members than whites. There is some evidence that relational factors contribute to gender differences in the receipt of social support, however. Interviews with workers suggest that gender schemata, the sex-typing of networks, reactions to racial discrimination, and differences in the value placed on social support contribute to race and gender differences in social support.     

Enhancing Wellbeing in Social Work Students: Building Resilience in the Next Generation

The need for social workers to be resilient is widely emphasised. Although enhancing resilience in social work trainees presents a challenge to educators, they are nonetheless responsible for developing professionals who are able to cope with the emotional demands of the job. This paper argues that building resilience in the future workforce should be a key element of social work education. However, as little is known about the competencies and support structures that underpin resilience or the extent to which resilience protects the wellbeing of trainees, an evidence-based approach is required to inform curriculum development.

Recent research conducted by the authors of this paper has highlighted the protective nature of resilience in social work trainees. Emotional intelligence and associated competencies, such as reflective ability, aspects of empathy and social confidence, were found to be key predictors of this important quality. The important role played by social support from various sources was also emphasised. The present paper summarises this research, and presents interventions based on the findings that have the potential to promote resilience and wellbeing in social work trainees. Also considered are ways in which the curriculum might be further enhanced to provide trainees with an internal ‘tool-box’ of strategies that will help them manage their wellbeing more effectively in their future career.     

Treatment for Hoarding Behaviors: A Review of the Evidence

This article reviews the empirical literature on treating clients with hoarding behaviors, including psychosocial treatments, mainly cognitive behavioral, and pharmacotherapy. Standard treatments used for obsessive compulsive disorder (OCD) such as medication and/or behavior therapy have been associated with poor treatment response for those with hoarding. Recent prospective pharmacotherapy research suggests that serotonergic medication may be helpful to OCD patients with or without hoarding. A multi-component cognitive behavioral treatment (CBT) designed specifically for hoarding has shown promising results especially in trials of individual therapy with periodic home visits. Social work researchers have played a prominent role in the development and testing of this CBT intervention and development of instruments to assess hoarding treatment outcomes. This CBT intervention has demonstrated modest success when delivered individually in an open trial and a waitlist-controlled trial, and in quasi-experimental studies of group treatment modalities, including in-person and web-based groups as well as bibliotherapy-based support groups. Overall, evidence supports the use of specialized CBT methods to improve hoarding symptoms. Future testing may include controlled trials with more diverse samples.     

Child‐focused Parenting after Separation: Socio‐legal Developments and Challenges

In this article I utilise developing ideas in family law as a backdrop against which to discuss changing assumptions about parenting. In particular, I examine the gender‐neutral assumptions within family law in Australia and elsewhere in the light of seemingly contradictory evidence about the value of post‐separation fathering. That men were equally capable of providing effective parenting was by no means clear at the time that the principle of gender‐neutrality became common in family law—the 1960s and 70s. Only recently, has burgeoning research on fathering begun to more clearly affirm its value and to clarify the conditions under which pre and post separation fathering makes a positive difference. Paradoxically, it is at this very time that legally based challenges to the gender‐neutral, shared‐parenting philosophy of the 1995 Australian Family Law Reform Act have begun to emerge. The often‐perplexed interface between law, social science research and therapeutic intervention presents many challenges. I conclude the article by flagging a number of questions relevant to family therapists in this difficult field of work.     

Estimation and interpretation of models of absolute risk from epidemiologic data,including family-based studies

Absolute risk is the chance that a person with given risk factors and free of the disease of interest at age a will be diagnosed with that disease in the interval (a, a + τ]. Absolute risk is sometimes called cumulative incidence. Absolute risk is a “crude” risk because it is reduced by the chance that the person will die of competing causes of death before developing the disease of interest. Cohort studies admit flexibility in modeling absolute risk, either by allowing covariates to affect the cause-specific relative hazards or to affect the absolute risk itself. An advantage of cause-specific relative risk models is that various data sources can be used to fit the required components. For example, case–control data can be used to estimate relative risk and attributable risk, and these can be combined with registry data on age-specific composite hazard rates for the disease of interest and with national data on competing hazards of mortality to estimate absolute risk. Family-based designs, such as the kin-cohort design and collections of pedigrees with multiple affected individuals can be used to estimate the genotype-specific hazard of disease. Such analyses must be adjusted for ascertainment, and failure to take into account residual familial risk, such as might be induced by unmeasured genetic variants or by unmeasured behavioral or environmental exposures that are correlated within families, can lead to overestimates of mutation-specific absolute risk in the general population.     

Essential emotions: The place of passion in a feminist network

Using a case study, the authors argue that emotions play a highly significant part in voluntary organizations, and that present significant part in voluntary organizations, and that present academic approaches to emotions are unhelpful, both theoretically and practically. The distinction between emotional work and emotional labor is unclear in nonprofit organizations using volunteers. More research is needed in this area.     

Concurrent reductions in psychotropic medication,assault, and physical restraint in two residential treatment programs for youth

Over the past decade, the level of clinical needs of youth in residential treatment has increased significantly. Youth in out-of-home settings typically experience higher levels of psychotropic medication use than their peers living at home, even when controlling for the severity of clinical issues. The purpose of the current study was to examine the effects of an approach to clinically reassess psychotropic medication utilization for youth residing in residential treatment settings while also observing the impact on the youth's need for physical containment. Medication changes were based on a data-informed process, using input from a multi-disciplinary treatment team. Data for 531 youth who were consecutively admitted to one of two non-affiliated intensive residential treatment programs, one in the Midwest and one in New England, was analyzed. Over half of these youth (n = 292, 55%) had their medications reduced during their stay and only 14% (n = 76) were prescribed more medication at discharge than they had been taking at admission. The remainder either saw no change during their stay (n = 104, 20%) or were never on medication at any time (n = 59, 11%). From admission to discharge there was a 62% decrease in the number of assaultive incidents as well as a 72% decrease in the use of physical restraints. These results support the view that residential treatment can provide a treatment milieu that allows for thoughtful reassessment of the clinical basis for behavioral disorders in children that can achieve the dual goals of medication reduction and behavioral stabilization.