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PubMed1992

The Patient Self Determination Act: opportunity knocks again.

The recent Patient Self Determination Act (PSDA) gives patients the right to exercise greater control over the care they receive from health care facilities and programs during the final phases of their lives. Social work can make important contributions to health care facilities as they develop policies and programs for implementing the Act's provisions about advance directives and refusal and withdrawal of treatment.

Advance Directives↗
PubMed1999

Update on psychosocial research on leukaemia for social work practitioners.

This article describes an Australian initiative that has undertaken the challenge of establishing a permanent psychosocial research program on leukaemia and associated haematological disorders to inform service provision and policy development for patients and their families. The description of this initiative is set in the context of a summary of the present research that exists in this area. This research indicates that this is a group of patients with a high rate of morbidity who, along with their family and carers, are vulnerable to physical, social, emotional and spiritual distress. The discussion concludes with a description of research projects that are presently being undertaken to extend our understanding of the psychosocial issues associated with these diagnostic groups.

Adolescent↗
PubMed1987

Is being poor a mental health hazard?

From a perspective of needs, risks and tasks of women throughout the life and family cycle the paper examines relationships between mental health and poverty by reviewing observed determinants and concomitants of poverty as well as stressors and risks associated with women's socioeconomic position, environmental conditions, and social roles. As a tool for policy development, a three-anchor needs proposition and a coping schema and formula are proposed as a new conceptual framework for appraising women's hazards and strengths. The poverty status of women in Canada is also reviewed.

Adaptation, Psychological↗
PubMed2000

Children in group homes: family dynamics, adolescent suicide attempts and drug use.

Three hundred children age 10-20 living in group homes for children were assessed for behaviors related to alcohol and other drug consumption, suicide attempts, frequency of punishment, attention from parents, conflicts with parents, and other family dynamics. Children who used substances were significantly more likely to have attempted suicide more frequently. Children who had attempted suicide were more likely to perceive that they had not received enough parental attention, to have had more conflicts with parents, and to have run away from home. This seminal article indicates inter-related prevalences of family factors, suicide and substance abuse issues and suggests the need for strong institutional and agency policy development for this understudied "at risk" population.

Adolescent↗
PubMed2002

Leadership/citizen participation: perceived impact of advocacy activities by people with physical disabilities on access to health care, attendant care and social services.

Increasingly, the climate of shrinking health care resources will impact access to health care for the people most vulnerable-those with disabilities. This study looked at the perceived impact of leadership and participation by people with physical disabilities and at their ability to gain increased access to health care, attendant care and social services. Respondents were randomly selected from Canada and the United States, from a pool of participants with physical disabilities serving in leadership roles within disability organizations in either country. Responses from a mail-out survey questionnaire were tabulated using logistic regression procedures to identify the perceived impact of advocacy activity on improved access to health care, attendant care and social ser- vices. Findings suggest that those who participated in advocacy activities were significantly more likely to feel that their action improved access to health care resources, attendant care resources and social services. Advocates also perceived the impact of access for their family, local organizations, and at a regional/national level. This study highlights the value of consumer/citizen participation, and the vital role this action can play in collaboration with social work professionals for system changes, health resource planning and policy development.

Canada↗
PubMed2002

Missed opportunities and unlimited possibilities: teaching disability content in schools of social work.

The issue of disability is paramount to the delivery of social services to a vulnerable population--a noble cause of the social work profession. Yet social workers are not the purveyors of services to the disabled. As a way of determining the impact of social work in the field of disability, an analyses of courses are made of disability and school social work content. While this comparison of courses may seem perilous it is important to note that a significant portion of the disabled community are serviced in the schools. The purpose of this article is to raise the professional consciousness of social workers to their responsibility to the treatment and policy development for those who have disabilities. It challenges schools of social work to re-think their course offerings or to reorganize course content to include more information on disabilities.

Curriculum↗
PubMed2005

Racial and ethnic diversity among a heroin and cocaine using population: treatment system utilization.

Knowledge about the meanings and consequences of behaviors associated with drug use among diverse populations is essential for developing effective public health and clinical strategies. In this study we identify racial/ethnic variations in patterns of drug use, Addiction Severity Index (ASI) scores, response to intervention, concordance between self-report of drug use and biochemical confirmation, and treatment system contacts in a sample of 1175 out-of-treatment cocaine and heroin users drawn from a trial of brief motivation in the outpatient clinics of an inner-city academic hospital. Key differences were identified in drug of choice, in all of the ASI domains except medical, in validity of self-report of use, and in rate of treatment contact. Differences related to race and ethnicity should be evaluated to determine needs for a variety of substance abuse treatment modalities, assure timely access to culturally competent care, and develop policies that are tailored to real conditions.

Adult↗
PubMed2005

Differences in family functioning and health between older adult volunteers and non-volunteers.

The purpose of this investigation was to identify differences in family functioning and health between older adult volunteers and non-volunteers. Two findings emerged from the data: volunteers reported higher family functioning as well as better health compared to non-volunteers. Implications for social workers involved with volunteer programs and services are discussed in terms of volunteer recruitment and retention, and the related need to develop policies that permit more flexibility and choice with regard to volunteer responsibilities.

Aged↗
PubMed2006

Hearing the voices of abused older women.

This paper focuses on a qualitative research process that gathered responses from 64 older women aged fifty and older on their experience of violence and abuse. What older women said about abuse in their lives supports the use of a feminist framework as well as the age based analysis of the elder abuse field. Some respondents spoke of abuse from childhood into their later years. Some spoke of partners witnessing or experiencing abuse as children. Some women express concern about possible abuse by their adult children of their own children. Abused older women like younger women need a safe environment, emotional support, advocacy, information, and peer support. While it is important to consider the perspectives and knowledge of service providers when developing policy and practice on abuse of older women, it is critical to ask the women survivors of abuse or neglect what they believe would benefit them, and others in similar situations.

Age Factors↗
PubMed2006

Understanding of basic financial concepts among adults with mild learning disabilities.

OBJECTIVE: In the context of recent legal and social policy developments, which encourage clinicians to support vulnerable adults in making their own financial decisions, we explored understanding of basic financial concepts among adults with mild learning disabilities. METHOD: Using the literature about typically developing children, five measures entailing identification and ordering tasks were devised and were used to examine understanding of quantity, numbers and money among 30 men and women using specialist clinical services (mean FSIQ = 61.80; SD=10.59). RESULTS: The concept of quantity was easier to understand than those of numbers and money, and task difficulties increased with the magnitudes involved. The different types of conceptual understanding were closely related. CONCLUSIONS: These measures may be useful for analysing difficulties in, and informing interventions to maximize, independent financial decision making.

Adolescent↗
PubMed2001

Beyond sex and cooking: health education for individuals with intellectual disability.

Issues of health education programming for people with intellectual disability are discussed. As environments in which such individuals live become more inclusive, and they are encouraged to make their own choices, the issue of whether current health education is sufficient to enable them to make healthy life choices is considered. More attention should be focused on programs in schools and the community to fulfill this need. Three aspects of health education programming are considered: physical activity, general health knowledge, and social supports for health. Continuity of information is viewed as important in policy development as well as in interprofessional coordination and cooperation to assure that these individuals are not further handicapped by poor health.

Cooking↗
PubMed2006

Community health center integration: experience in the State of Ohio.

In the face of severe financial challenges and demands to improve quality and service to patients, many community health centers (CHCs) have aligned or integrated with other CHCs, physician groups, or hospitals. Yet the nature of and rationale for these organizational decisions are not well understood. Our research applied an organizational theoretical framework to test whether strategic adaptation theory or institutional theory best describes the integration activity of CHCs in Ohio. We collected primary data from case studies of seven CHCs selected for geographic representation and studied December 2000-January 2001. Semi-structured interviews and a case study database supported our chain of evidence. We found that CHC integration activity was substantial (five of seven CHCs integrated) and extremely varied. Consistent with strategic adaptation theory, we determined that CHC integration actions were predominantly center-specific, rational responses to environmental challenges and were initiated to improve operations or financial performance. Rarely did CHCs initiate major organizational change merely to mimic other CHC actions, as might have been expected of highly institutionalized organizations. Understanding the basis for CHCs' strategic decisions while monitoring financial health will remain critical as lawmakers and administrators work to develop policies that both maintain progress made and improve primary care access for the poor, the uninsured, and those with special health care needs served by these important safety net providers.

Community Health Centers↗
PubMed1997

Public health in a managed care environment.

As the health care system moves in a new direction, toward managed care, the critical role of public health in society's efforts to mitigate illness and the realization of health become more apparent. Indeed, the public health problems of this era will not yield to simple solutions. They require a multitude of resources, both human and material, and a myriad of services derived from these resources. Public health's role is to serve as the government's presence in assessing health status, developing policy, evaluating the effectiveness of policy implementation, and assuring access to and quality of comprehensive health services. Increasingly, public health must coordinate a wide array of systems in both the private and public sectors to fulfill its purpose.

Community Health Planning↗
PubMed2006

Dementia before death in ageing societies--the promise of prevention and the reality.

BACKGROUND: Dementia and severe cognitive impairment are very closely linked to ageing. The longer we live the more likely we are to suffer from these conditions. Given population increases in longevity it is important to understand not only risk and protective factors for dementia and severe cognitive impairment at given ages but also whether protection affects cumulative risk. This can be explored by examining the effect on cumulative risk by time of death of factors found consistently to reduce risk at particular ages, such as education and social status. METHODS AND FINDINGS: In this analysis we report the prevalence of dementia and severe cognitive impairment in the year before death in a large population sample. In the Medical Research Council Cognitive Function and Ageing Study (a 10-y population-based cohort study of individuals 65 and over in England and Wales), these prevalences have been estimated by age, sex, social class, and education. Differences have been explored using logistic regression. The overall prevalence of dementia at death was 30%. There was a strong increasing trend for dementia with age from 6% for those aged 65-69 y at time of death to 58% for those aged 95 y and above at time of death. Higher prevalences were seen for severe cognitive impairment, with similar patterns. People with higher education and social class had significantly reduced dementia and severe cognitive impairment before death, but the absolute difference was small (under 10%). CONCLUSIONS: Reducing risk for dementia at a given age will lead to further extension of life, thus cumulative risk (even in populations at lower risk for given ages) remains high. Ageing of populations is likely to result in an increase in the number of people dying with dementia and severe cognitive impairment even in the presence of preventative programmes. Policy development and research for dementia must address the needs of individuals who will continue to experience these conditions before death.

Age Factors↗
PubMed2005

Treatment preferences for resuscitation and critical care among homeless persons.

CONTEXT: Homeless people are at increased risk of critical illness and are less likely to have surrogate decision makers when critically ill. Consequently, clinicians must make decisions independently or with input from others such as ethics committees or guardians. No prior studies have examined treatment preferences of homeless to guide such decision makers. DESIGN: Interviewer-administered, cross-sectional survey of homeless persons. SETTING: Homeless shelters in Seattle, WA. PARTICIPANTS: Two hundred twenty-nine homeless individuals with two comparison groups: 236 physicians practicing in settings where they are likely to provide care for homeless persons and 111 patients with oxygen-dependent COPD. MEASUREMENTS: Participants were asked whether they would want intubation with mechanical ventilation or cardiopulmonary resuscitation in their current health, if they were in a permanent coma, if they had severe dementia, or if they were confined to bed and dependent on others for all care. RESULTS: Homeless men were more likely to want resuscitation than homeless women (p < 0.002) in coma and dementia scenarios. Homeless men and women were both more likely to want resuscitation in these scenarios than physicians (p < 0.001). Nonwhite homeless were more likely to want resuscitation than white homeless people (p < 0.033), and both were more likely to want resuscitation than physicians (p < 0.001). Homeless are also more likely to want resuscitation than patients with COPD. The majority (80%) of homeless who reported not having family or not wanting family to make medical decisions prefer a physician make decisions rather than a court-appointed guardian. CONCLUSIONS: Homeless persons are more likely to prefer resuscitation than physicians and patients with severe COPD. Since physicians may be in the position of making medical decisions for homeless patients and since physicians are influenced by their own preferences when making decisions for others, physicians should be aware that, on average, homeless persons prefer more aggressive care than physicians. Hospitals serving homeless individuals should consider developing policies to address this issue.

Adult↗
PubMed1990

The Ventilator-assisted Individuals Study.

A paucity of reliable data exists concerning ventilator-assisted individuals (VAIs) for program planning. The Chicago Lung Association, with funding from Blue Cross/Blue Shield of Illinois, conducted a community action project to determine the magnitude of the issues in Illinois. The purposes of the VAI Study were to ascertain needs and resources, generate recommendations, and recruit community involvement. The survey identified 453 VAIs: 145 in hospitals, 105 in extended-care facilities, and 203 at home. A majority (62 percent) of hospitals provided services to VAIs; many more would with proper reimbursement incentives. Only 60 percent of hospitals serving VAIs had active discharge teams; discharge was accomplished by a variety of mechanisms and personnel. Monthly hospital charges averaged $22,190 with a range from $10,020 to $66,750 depending on the location of the patient. Most reimbursement was public; private funding was fragmented. Major discharge barriers were inadequate payment for community-based services, limited community resources, constrained consumer's finances, and lack of access to information. Recommendations for future community action included establishing a technology transfer system, home care case management, an integrated management system, a documentation center, and trials and demonstrations prior to program and policy development.

Adult↗
PubMedDate not supplied

Alcohol use and abuse amongst adolescents in Hong Kong.

This paper discusses alcohol use and abuse amongst adolescents in Hong Kong on the basis of a thorough literature review of official statistics and empirical research. The review highlights four major observations. Firstly, the alcohol culture of Hong Kong adolescents is basically positive and social-oriented. The existing legal constraint on the use of alcohol by those aged under 18 seems to exist in name only. Secondly, the past decade has seen a rising trend in alcohol use by adolescents, both in terms of those who have ever consumed it and those who do so currently. Thirdly, several demographic variables associated with alcohol use have been identified, including gender, age, and school mode. Fourthly, peer interactions (such as involvement in organized criminal groups) and family factors (such as lack of maternal support) are also related to alcohol use in young people. The paper closes by making some observations on the gaps in the research and sets forth some ideas for future policy development.

Adolescent↗
PubMed2006

Does availability of mental health resources prevent recurrent suicidal behavior? An ecological analysis.

This study examines whether availability of mental health resources in the county of residence is associated with subsequent suicidal behavior after a previous suicide attempt. Among 10,922 individuals who attempted suicide in Colorado between 1998 and 2002, residence in a county that offered a minimum safety-net of mental health services significantly reduced the risk of suicidal behavior for at least 1 year after the index attempt. Safety-net services included mental health treatment, crisis treatment, and case management. These results suggest one strategy for prevention of suicidal behavior that could inform state-level health policy development and resource allocation.

Adolescent↗