Risk-Reducing Legal Documents: Controlling Personal Health and Financial Resources

Every adult can eliminate the risk of losing control of personal health decisions and financial resources by having a last will and testament, health proxy, power of attorney, and living trust. Yet evidence suggests that less than a majority of adult Americans have these documents. We surveyed 900 adult Americans (25 plus years old) to determine what factors predict the possession of these risk-reducing documents. In total, 46% had a living will and testament, 32% a durable power of attorney, 30% a health proxy, and 18% a living trust. Events that prompt people with wealth to secure these documents, such as increasing age, getting married, having children, and experiencing a life-threatening event were the strongest predictors of having a will. These were also among the strongest predictors of having a health proxy, along with a personal history of being proactive, and a family history that fostered trust of attorneys. Affluence, age, and education were the strongest predictors of having a living trust, and the strongest correlate of having a durable power of attorney was having faced a life-threatening event, positive experiences with attorneys, and higher educational achievement.     

Lesbian,Gay, Bisexual,Transgender, Queer/Questioning (LGBTQ) Perceptions and Health Care Experiences

The goal of this study was to explore attitudes, health knowledge, and experiences with health care setting and providers among lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) individuals and to identify areas for improvement. Members of Equality Florida? residing in the five counties of the Tampa Bay region were recruited through e-mail invitation to complete a 60-item questionnaire assessing demographics, attitudes, and experiences with health care providers (HCPs). Additional open-ended questions focused on experiences with HCPs and suggestions for ways to improve HCPs' cultural competency. A total of 632 respondents completed the survey of which 41% were gay men and 29% were lesbian. The majority of participants were White, non-Hispanic (93%), married/partnered (78%), and had health insurance (88%). The majority (67%) reported they always or often disclosed their sexual orientation/identity to an HCP and few had negative reactions in the health care setting (<10%). Health care settings with equality signs and gender-neutral language were perceived as safer. Participants' responses suggested need for policy changes and improved cultural competence among HCPs. Results show high rates of sexual orientation disclosure, greater acceptance from providers of LGBTQ status, and the need for examination of hospital policies and improved cultural competency.     

Health conditions in rural and urban areas of developing countries

The poor quality and meagre supply of data prohibit conclusions as to the relationship of health status to rural-urban residence in underdeveloped countries. Demographic indicators of health, specifically infant mortality and average life expectancy, do not seem to vary systematically according to rural-urban residence in the less developed countries ofAsia, Africa and Latin America. Further differences between rural and urban areas in availability of health services and facilities do not always conform with apparent differences between the areas in health status. However, nutritional standards, housing conditions, and sanitation, water supply and other pertinent environmental circumstances account to some extent for differences observed in health status between rural and urban inhabitants of these countries.     

A systematic review on community-based interventions for elder abuse and neglect

Elder abuse and neglect is a societal issue that requires prevention and intervention strategies at the practice and policy level. A systematic review on the efficacy of community-based elder abuse interventions was undertaken to advance the state of knowledge in the field. The peer-reviewed literature between 2009 and December 2015 were searched across four databases. Two raters independently reviewed all articles, assessed their methodological quality, and used a modified Sackett Scale to assign levels of evidence. Four thousand nine hundred and five articles were identified; nine were selected for inclusion. Although there was Level-1 evidence for psychological interventions (n = 2), only one study on strategies for relatives (START) led to a reported decrease in elder abuse. There was Level-4 evidence for conservatorship, an elder abuse intervention/prevention program (ECARE), and a multidisciplinary intervention (n = 4), in which one study yielded significant decreases in elder abuse and/or neglect. The remaining three were classified as Level-5 evidence (n = 3) for elder mediation and multidisciplinary interventions. There are limited studies with high levels of evidence for interventions that decrease elder abuse and neglect. The scarcity of community-based interventions for older adults and caregivers highlights the need for further work to elevate the quality of studies.     

Recovering from Homelessness: Determining the “Quality of Sobriety” in a Transitional Housing Program

Recent years have seen fundamental shifts in the objectives and delivery of assistance to the homeless. An early emphasis on emergency shelter and monetary housing assistance has been replaced by a focus on programs designed to blend shelter with an array of social services. In most instances, however, programs combining shelter and social services are designed as transitional; that is, they are intended to help homeless individuals and families move from a position of dependence to one where they can live independently. The emphasis in transitional housing programs is on making homeless people housing ready. This paper concerns the process of assessing housing readiness as observed during eighteen months of fieldwork in a federally supported transitional housing program for formerly homeless single adults. The detailed case study that follows supports three important findings. First, there was virtual unanimity among staff and residents that substance abuse was the cause of their homelessness and the key to its solution. Second, success within the program was defined and operationalized along very specific but well understood normative dimensions that have little to do with the material circumstances in which residents find themselves and everything to do with recovery. Third, recovery—the key to housing readiness in this environment—was measured not by objective measures, i.e., number of months sober, but rather by what was widely referred to as one's quality of sobriety, a subjective and consequently often hotly debated measure of attitude and outlook only loosely related to demonstrable abstinence from alcohol. This last finding, that ultimately housing readiness is a subjective judgment, both increases the discretion of shelter staff and generates a systematic disattention to the individual economic issues that are fundamental to an exit from homelessness.     

“I Only Want to Know What You Know”: The Use of Orienting Messages During Forensic Interviews and Their Effects on Child Behavior

The purpose of this research was to evaluate orienting messages within the CornerHouse Forensic Interview Protocol in two formats: provided both at the outset and as needed throughout the interview compared to previous practice in which orienting messages were provided only as the opportunity arose. Through the content analysis of 120 videotaped forensic interviews and corresponding case files in which children were interviewed for sexual abuse allegations, results suggest that the use of orienting messages both at the beginning and as needed lead to significantly more autonomous responses from children, that use of more orienting messages was significantly related to more autonomous responses from children, and that the specific orienting messages of “can’t/won’t say” and “ask me a question” significantly predict more autonomous responses among children. Implications for practice include the use of orienting messages as a way to provide a respectful and safe experience for children participating in forensic interviews.     

The Continuum of Disclosure: Exploring Factors Predicting Tentative Disclosure of Child Sexual Abuse Allegations During Forensic Interviews and the Implications for Practice,Policy, and Future Research

When a child sexual abuse investigation ensues, many children do not disclose readily to professionals. Defining disclosure beyond the disclosure versus nondisclosure dichotomy is essential, yet little research exists on factors associated with a continuum of disclosure, including active and tentative disclosure. Through the coding of 196 forensic interviews using content analysis and subsequent regression analysis, findings suggest that children of color, children abused by adults, unintentional initial disclosure, and those lacking family support were more likely to tentatively disclose in this study. Implications include a need to understand tentative disclosure as part of a normal continuum of disclosure within court proceedings and investigations of abuse allegations.