Conversations at the end of life:the challenge to support patients who consider death with dignity in Oregon

Oregon's Death with Dignity Act (ODWDA) has been in effect for eight years. The United States Supreme Court recently decided that Oregon's law did not violate the Controlled Substances Act. Other states may consider a law similar to Oregon's through legislative process or ballot measures. Although social work is not mentioned in the law, our profession interfaces with the terminally ill, particularly in hospice. Eighty-seven percent of those who have used the law were enrolled in a hospice program. As a pilot project, this article explores conversations that the authors have had with patients, families, team members and health systems in hospices and oncology settings under Oregon's unique environment. The following four themes emerged from these conversations: (1) mental health, education, choice; (2) team concerns; (3) family issues; and (4) values, ethics, restricted conversations and professional struggles.     

Effects of an introductory letter on response rates to a teen/parent telephone health survey

The authors conducted a pilot study in preparation for a larger investigation that will rely on telephone surveys to assess select health behaviors of teens and their parents, with a focus on indoor tanning. This study used a randomized design to assess the impact of a presurvey letter on response rates to a telephone survey, as well as prevalence estimates of ever having used an indoor tanning facility. The letter did not have a significant effect on response rates or prevalence estimates in the two cities under study. Findings suggest that researchers should not assume that a letter sent in advance of a telephone survey will necessarily increase response rates enough to justify their use.     

Mental health issues and the foster care system: an examination of the impact of the Adoption and Safe Families Act

Although marriage and family therapists are being called on to help at-risk families, some say that clinicians have insufficient knowledge about the impact of policies on families involved in the foster care system. The purpose of this qualitative investigation was to identify how the Adoption and Safe Families Act informs decision making, to recognize trends in decisions regarding termination of parental rights of parents with mental health issues, and to explore treatment issues of families involved in the foster care system. Results indicate that court cases decided after the implementation of the Adoption and Safe Families Act are likely to result in termination of parental rights. Implications for clinicians and researchers are discussed.     

From the streets to assisted living: perceptions of a vulnerable population

The rapid growth of assisted-living facilities is paralleled by the necessity to understand the needs of the people living in them. A hallmark challenge for individuals who are poor and disabled, and often marginalized from mainstream society, is maintaining integrity and being a whole person, rather than a sum of broken parts. A key to maintaining this integrity is the ability to find stable housing and support systems. The inner-city assisted-living facility in this study is unique in that all of its residents are funded by Medicaid. The residents have complex needs related to histories of homelessness, mental illness, drug and/or alcohol addiction, and chronic illness. The purpose of this study was to explore the needs of this vulnerable population as they adapt to a new home and a new concept of assisted, yet independent, living. Structured interviews with key informants and oral survey questionnaires with residents provided quantitative and qualitative data about physical and mental health status, social support, perception of control, psychological wellbeing, and life satisfaction. This study provided valuable insights into the challenges inherent in providing a high quality of life in assisted living for a vulnerable population with diverse needs.     

Aging on the job

The older population is growing faster than the population as a whole. Paid work is the main mechanism for physical activity in humans. We, therefore, wanted to ascertain whether work practices (such as employment status and the types of tasks workers perform) follow the biological decline in physical activity that occurs with aging in humans and many other species. We recorded work practices in 3352 adults in the Ivory Coast to establish how work burdens are distributed across different age groups in a community that is minimally fettered by legal constraints. We found a decrease in the amount of work performed with increasing age, and we found that elderly persons performed more skilled, less exothermic tasks than younger workers. These data mirror global workforce distribution trends expressed by age. If the trend continues, a major portion of the population will be unlikely to contribute to the labor force in the near future, producing potentially adverse economic consequences in some populations. Although the problem might be averted or at least minimized by implementing different employment policies, biological factors could overlay and supervene any economic planning.     

Enhancing the rights and well‐being of people with acquired brain injuries in the criminal justice system: Some findings from a qualitative study

This article focuses on the issues currently facing people with an acquired brain injury (ABI) in the criminal justice system in the state of Victoria, Australia and, in particular, the impact of this condition on people suffering various forms of social disadvantage. This qualitative study involved in‐depth interviews with key stakeholders, such as service providers working in the system, court personnel including Magistrates and Judges, legal practitioners and persons living with an ABI and their carers. The aim was to determine the advantages and limitations of current policy and practices, and to identify possible actions which could lead to improved outcomes for this cohort. This paper responds to our research findings in relation to two key areas: first, the awareness of ABI amongst legal practitioners and service providers, prompting the need for better education, training and professional development; and second, the requirement to improve processes for identification, assessment and support, for people involved in the criminal justice system with ABI. A number of systemic modifications and educational initiatives are recommended to address the unreasonable and unacceptable impacts on persons living with an ABI in the criminal justice system.     

Migration, Displacement, and Violence: Prosecuting Romanian Street Children at the Paris Palace of Justice

This paper examines the displacement and vulnerability associated with the migration of unaccompanied illegal Romanian minors who came as economic migrants to Western Europe, found no legal opportunities for work or education, and were forced into criminal activity on the streets of French cities such as Paris, Lyon, and Nice. Beginning in 1997 growing numbers of unaccompanied Romanians, mostly boys, some as young as age ten, many younger than age 15, were subject to systematic prosecution rather than protection in Paris, the site of the largest and most influential juvenile court in the nation. They were arrested, detained, indicted, released pending trial, judged, and sentenced in absentia, multiple times with different identities. The Romanian minors were caught without legal papers or visas, claimed to be squatters living in abandoned buildings, trailers, or camps outside Paris, and gave little reliable information about their families or lives. Initially arrested for the destruction of city property and the theft of the proceeds from city parking meters, they gradually turned to begging, shoplifting, and prostitution when the city switched from coin to card payment. Deeply concerned by the penalization of a vulnerable population, the president of the Paris juvenile court created a special court to deal more humanely with unaccompanied minors in general, and Romanian children in particular, by establishing their identities and reconnecting them with their families. This article explores the contradictions that emerged between the representation of Romanian children in the media, the legal establishment, nongovernmental organizations (NGOs), and the Government, on the one hand, and their treatment in the juvenile justice system, on the other. It examines the discourse and the context of judging as well as the interactions between court personnel and Romanian minors from in‐take interviews in jail and indictment hearings in chambers to judgment in absentia in the formal court. It compares and contrasts cases heard before and after the creation of the special court and centres on the gaps between official rhetoric, legal norms, and judicial practice. It concludes that the creation of the special court may be having the unintended effect of reinforcing and institutionalizing the very judicial practice it was designed to prevent, namely the penalization of marginality.     

Disclosure and Relationship Satisfaction in Families

The present study developed a theoretical framework for understanding the social mechanisms underlying disclosure and its link with relationship satisfaction in a full family design. A study among 262 intact families, consisting of 2 children and 2 adults and involving 1,048 individuals, applied the social relations model. Results showed that disclosure was more important to satisfaction in horizontal relationships than vertical ones. Further, relationship‐specific disclosure was more important to satisfaction than dispositional disclosure. These results have implications for the examination of relationship regulation and maintenance in (non)voluntary relationships and the development of psychosocial problems in parent‐ child relationships.     

Anorexia nervosa in males: A case report and review of the literature

Only 5–10% of the diagnosed cases of anorexia nervosa occur in males. Anorexia nervosa can be difficult to identify in males because it may occur in a different subset of the population as compared to females and because anorectic males use different terms to express conflicts regarding body size and shape than their female counterparts. This case study illustrates how a young prepubescent male responded to traumatic events in his life by developing anorexia nervosa with an eventual loss of 33% of his premorbid weight. Precipitants of this patient's illness were his parent's divorce, his mother's remarriage, a precipitous relocation, his mother's pregnancy, and his sister's development of a life-threatening disease, all occurring during the early stages of puberty. The study concludes that anorexia nervosa in young males can result from multiple psychologically traumatic events which occur at a particular stage of development.