Unmet needs at the end of life: perceptions of hospice social workers

Among persons at the end of life, it is important to understand whether the needs of patients are being adequately addressed. In particular, in hospice settings where the emphasis is on comfort care and quality of life, we know little about the presence of unmet needs. The purpose of this study was to examine the experiences of hospice social workers in working with hospice patients who had unmet needs at the end of life. Surveys were mailed to hospice social workers (N = 212) in two Southeastern states with a response rate of 36%. Results revealed that hospice social workers perceived patients to experience a wide variety of unmet needs-more commonly at the time of admission than during subsequent patient interactions. The most common unmet need reported at both times was a decreased ability to participate in activities that make life enjoyable. In situations where unmet needs exist, social workers reported that the most common perceived reasons were patient- related psychosocial issues and family conflict/issues. Additionally, a variety of interventions were used to address unmet needs, but a large number of barriers appear to impact outcomes in the cases. Results suggest that hospice patients experience a number of unmet needs, many of which are potentially treatable problems and concerns. Hospice professionals must continue to seek ways to assess and intervene effectively with patients who have unmet needs.     

Children's understanding of mental ill health: implications for risk and resilience in relationships

Research shows that having a parent with a mental health problem has associated risks for children, but some families seem very resilient and do not always suffer these difficulties. In order for social workers to be able to support the development of resilience in families who appear to be at risk, we need to understand what factors may ameliorate some of these risks. Research seems to suggest that children who can conceptualize their parent's mental health problem as something 'outside' their representation of that parent as an attachment figure are likely to have better outcomes than children who see the mental-health problem as part of, and embedded within, their representation of that parent. However, in order to develop an understanding of how this conceptualization affects attachment relationships and outcomes, we need to know what children understand by mental ill health. We also need to consider how this conceptualization might be changed, and it appears that parents, other attachment figures and other support figures may play a key role here. This paper provides a selective review of the research area and discusses the mechanisms which may govern this complex process. The review concludes with recommendations for future research and practice.     

Using video observation in the family context: The association between camera-related behaviors and parental sensitivity

Research on parental sensitivity often relies on video observation of parent–infant dyads. However, to date, no study has assessed both infants’ and parents’ interactions with the camera, and how this relates to parental sensitivity levels. This exploratory study micro-coded camera-related behaviors (CRB) by 4-month olds and their mothers and fathers on a 1-s time base, and examined the associations between those behaviors and parental sensitivity in 75 Dutch families. While parents’ CRB made up only 0.8% of total interaction time, infants’ made up 12%. Multi-level time-series analyses showed that infants’ CRB predicted mothers’. Infants’ CRB predicted fathers’ CRB, and vice versa. Maternal sensitivity was significantly lower when children looked at the camera for over one-third of total interaction time (Cohen's d = 1.26). These findings indicate further research is required to better understand how video observation might threaten ecological validity.