Opportunities for Prevention of Domestic Neglect and Abuse of the Elderly

Abstract

Recent research has demonstrated that domestic neglect and abuse of the elderly is not uncommon in the United States. It is a social problem that has not been extensively researched, however. One of the few studies, conducted in Michigan, found that the oldest and most frail elderly were a target group of elevated risk. Victims of neglect or abuse tend to be living with adult children or other informal caretakers who become neglectful or abusive when the burdens of providing care for a frail, elderly person interact with stress, little or no preparation for providing personal care over a long time span, medical problems of the caretaker, alcohol abuse, financial difficulties, and other situational factors. Family histories of neglect or abuse and other causal hypotheses have also been investigated. Recent studies are reviewed and found to be in general agreement regarding the nature and apparent dynamics of this emerging problem among the elderly. Opportunities for prevention are discussed in terms of current models of service to the aging and redirection of other public health and social services.     

A Research Revolution in Women's Health

SUMMARY

Women's health research initiatives are emerging with evidence that there are unique diagnosis and intervention factors that provide a window into the specific health needs of women. The evidence of the need for this gender-specific research is being spurred by the establishment of The Office of Research on Women's Health by the National Institutes of Health (NIH). A review of some of the more current and salient research findings that apply to women's health and the health needs of women in different lifestyles, at different stages of the life cycle is discussed. Also considered are women's roles in the health service delivery system and where they fit into the provision of services within the context of women's styles of accessing and using health care. Self-help and other support programs will be described as they apply specifically to women and a case will be made for providing comprehensive, multi-systemic women's health services in one facility at the community level through an overview of some of the more current and successful models.     

Doctoral Education in Clinical-Community Psychology

SUMMARY

This paper provides an overview of doctoral clinical-community psychology programs and highlights some possible future directions in training. Clinical-community doctoral programs were categorized as: (1) formally labeled clinical-community programs, (2) clinical programs with a formal community track, or (3) clinical programs with an informal community emphasis. Many graduates from these programs obtain a basic understanding and appreciation of community psychology through required or elective courses, and through contact with students and faculty involved in community research and action. Those students who focus their research and electives around community psychology obtain a thorough and in-depth training experience in community research and action. Changes precipitated by managed care will challenge current ways that psychological services are provided allowing for more community based, innovative, and preventive approaches for which community psychology training would be particularly useful. Greater flexibility in APA accreditation guidelines provide opportunities for greater flexibility within clinical-community programs. Doctoral programs in clinical-community psychology are positioned to lead the development of a public health and human service approach to doctoral training through the integration of community and clinical psychology.     

The Status of Preventive Care for the Aged

Abstract

One response to the growing needs of the elderly is to expand the scope of preventive care from the younger and middle aged cohorts to include an emphasis on preventive care for older people. In the past it has been difficult to consider prevention and aging as concepts which could co-exist because we can neither cure nor prevent aging. The potential of preventive care to improve, maintain, or lessen decline in the quality of life of the elderly has not been included in the definition or mainstream of prevention activities. This study identifies and reviews research and programmatic activities which have been reported in the literature over the last ten years in the area of prevention and aging. Topical areas and methodological approaches are explored to define what has been considered appropriate preventive care for the elderly. An evaluation process, meta-analysis, is used to assess the therapeutic effect and overall effectiveness of techniques in prevention and aging. These findings can be used in formulating future initiatives related to aging and prevention.     

Federal Support for Adoption Subsidies

ABSTRACT

Federal Title IV-E Adoption Assistance is an essential resource for states moving children from foster care to adoption. Secondary analyses indicate that federal funds support nearly half the costs of all adoption subsidies. Due to variations in eligibility, federal matching rates, and states' use of the program, the proportion of total subsidy costs supported by Title IV-E funds ranges from 25 to 72 percent among states. Multivariate analyses of recent adoptions demonstrate the importance of Title IV-E utilization for adopted children and their families, in that Title IV-E-eligible children are more likely to receive subsidies and to receive larger subsidies, compared to children who are not Title IV-E eligible. Variations in Title IV-E utilization have potential impacts on children, adoptive families and state child welfare agencies.     

The primary mental health project: Thirty years after

Summary

This article summarizes the 30‐year history of the Primary Mental Health Project (PMHP), a school‐based program for early detection and prevention of young children's school adjustment problems. The article first describes PMHP's rationale and basic practices, gives examples of how the project has grown and evolved over the years, and summarizes some of its important research findings. The report also reviews several more recent PMHP emphases including its systematic work in program dissemination and its active efforts to develop effective primary prevention program modules. PMHP's approach offers a bona fide alternative to mental health's established, after the fact, restorative ways.     

Mental Health Treatment Experiences and Expectations in Foster Care: A Qualitative Investigation

This study explores perspectives on mental health treatment experiences and expectations for youth in foster care and their foster parents. In-depth interviews were conducted and identified for major themes: (1) the dual stigma of foster care and mental health care; (2) the lack of engagement in mental health therapy; (3) trust issues with the therapist and other individuals; and (4) the desire to integrate mental health services with primary care services. These results have implications for mental health service delivery and suggest opportunities to improve mental health treatment through an integrated care approach.     

Synergy and Healing

Summary

There is a crisis in health care resulting from the scarcity of resources and the inequitable distribution of those resources toward those most able to pay. Two paradigms for the generation and distribution of resources are discussed. The scarcity paradigm, in which individuals must compete for scarce resources, dominates Western care and expresses and supports that crisis. The synergy paradigm, in which individuals share resources which are renewable and expanding, is rare in the West but could help alleviate that crisis. Three case studies of synergy in Western health care are presented, illustrating the nature and functioning of “synergistic community.” Dilemmas remaining in the introduction and maintenance of synergy within Western care are discussed.     

Effectiveness of a Cancer Education Program for Women Attending Rural Public Health Departments in North Carolina

SUMMARY

The Western North Carolina Cancer Awareness Program (CAP) was a four-year program, funded by the National Cancer Institute, to increase education and support services for the prevention and early detection of breast, cervical, and skin cancer among women receiving care in six rural county public health departments. Three health departments were selected as intervention units, and the remaining three health departments served as comparison units. Women age 20 and older were randomly selected in each health department. Women in the intervention group received a comprehensive health education program that included easy-to-read printed materials and telephone counseling dealing with breast, cervical, and skin cancer. Theoretical guidelines for development of the intervention program included the PRECEDE Model and the Health Belief Model. Overall, the results indicated that personalized education, which includes the combination of readable printed materials and telephone contact, can be effective in increasing some early detection behaviors for breast and skin cancer among women who attend public health departments. The value of telephone counseling as a comparatively inexpensive approach to individualizing health education has significant implications for the development of similar cancer education programs for underserved populations.     

Design and Implementation of Parent Programs for a Community-Wide Adolescent Alcohol Use Prevention Program

SUMMARY

Project Northland is a comprehensive community trial designed to evaluate programs for the primary prevention of alcohol-related problems during adolescence. It uses a community-wide model, that includes both demand and supply reduction techniques. The first phase of Project Northland (grades 6-8) was completed with the effective implementation of multiple, complementary programs including a multi-year social behavioral curriculum, intensive parental involvement components, peer leadership opportunities, and community-level changes through the formation of local task forces. This article describes the process used for developing and implementing the comprehensive parent interventions used during the first phase of the research, highlighting the elements that led to the successful implementation of the programs with very high participation rates by parents, their young adolescents, teachers, and community members.     

Clinical Application of the Service-Learning Model in Psychology

SUMMARY

Students in Abnormal Psychology who pursued a service-learning opportunity worked with troubled youth in the juvenile justice system. Consistent with an a priori hypothesis, results revealed the following pattern: (a) service-learning students and traditional students exhibited similar levels of academic performance early in the semester; and (b) as the semester progressed, and service-learning students became more involved in course-related service, they showed increasingly superior academic performance relative to traditional students. As hypothesized, service-learning students were more likely than traditional students to perceive themselves as: (a) achieving personal development in the area of social responsibility and (b) learning to apply course concepts to new situations. Preliminary evidence that the project made clinically significant contributions to the service agency is also presented. Innovations to be implemented in this ongoing project are discussed, and recommendations for research are noted.     

Introduction

SUMMARY

Previously homeless women (17) and men (12) were surveyed on their experience as a caregiver to physically challenged senior citizen clients (16 men, 13 women: age M= 64.7, SD = 16.8). Caregivers had training in service delivery and experience before the survey. More satisfaction than stress from providing care was reported by caregivers. Caregiving satisfaction was significantly positively related to global life satisfaction and a sense of personal vulnerability to being disabled. Caregiving stress was significantly negatively related to perceived knowledge of the disability. Overall, these previously homeless caregivers reported that providing care to the disabled was positive, and would be repeated and recommended to Others.     

Linking Academics and Social Learning

Abstract

This article examines how school staff conceptualize their work with youths in an alternative school for weapon policy offenders after having undergone at least one year of a whole-school violence prevention program conducted by the Syracuse University Violence Prevention Project. The article examines the intent of school staff, their ideas, perspectives, and language about youths, violence, and schooling, and provides insights into the challenges and benefits of a whole-school approach to violence prevention. Their insights highlight what is needed for a violence prevention program to be successful. A major issue raised in the article is the importance of linking social learning and academics in violence prevention strategies, and of sustaining collaborative efforts that connect conflict resolution to acts of justice and support for youths' intellectual and emotional lives.     

Chapter 9: Partnerships Between Health Professionals and Self-Help Groups

SUMMARY

The study aimed to identify the meanings and mechanisms of partnership between health professionals and self-help group members. The three project stages involved in-depth individual interviews of professionals (n = 47) and of members (n = 49) using a semistructured interview guide; separate group interviews of professionals and members to rank themes which emerged in Phase I, and a joint professional/member workshop. A Partnership Framework was developed. The predominant partnership characteristics identified by professionals were egalitarian, flexible, decreased professional control, understanding and shared goals; and by members were trusting, reciprocal, shared goals, flexible and understanding. The five critical obstacles to partnerships, from professionals' standpoint were communication, attitudes, role ambiguity, the format health care system and ideological conflicts, and from self-help groups' perspectives were knowledge, the system, skills deficiency, attitudes and ideological conflicts. The foremost mechanisms for achieving partnership according to health professionals involved education, clearinghouses, and role and goal clarification; to self-help group members, they entailed trust building, communication building, and education. [Note: italics denote consensus by professionals and members.]     

Alcohol and Other Drug Problems in Older Adults

SUMMARY

While there is considerable awareness and knowledge on the part of the health and human service community on the problems of the misuse and abuse of alcohol and other drugs in the general population, this unfortunately often does not extend to older adults, those who are 60+. Problems with alcohol and other drugs in older persons is in itself not a sudden crisis or new problem. However, as with any health problem affecting a specific demographic group, when the problem is not recognized and appropriately dealt with the repercussions pose greater risks for the individuals with the problem as well as for the larger community. This is particularly true in regard to older adults where natural physical changes and increased age related health risks can only be exacerbated by the misuse and abuse of substances.     

The Role of Community in Facilitating Service Utilization

SUMMARY

Guided by an integrated theory of parent participation, this study examines the role community characteristics play in influencing a parent's decision to use voluntary child abuse prevention programs. Multiple regression techniques were used to determine if different community characteristics, such as neighborhood distress and the community's ratio of caregivers to those in need of care, predict service utilization levels in a widely available home visiting program. Our findings suggest that certain community characteristics are significant predictors of the extent to which families utilize voluntary family supports over and above the proportion of variance explained by personal characteristics and program experiences. Contrary to our initial assumptions, however, new parents living in the most disorganized communities received more home visits than program participants living in more organized communities. The article concludes with recommendations on how community capacity building might be used to improve participant retention.     

Chapter 9: The Use of Law for Prevention in the Public Interest

Summary

One of the most important functions of law and the legal system is to prevent harm by regulating conduct prospectively. Almost all law—whether in the form of a statute enacted by a legislative body or a judgment decreed by a court—is designed, at least in part, to avoid some socially undesirable future state of affairs. This chapter explores some of the more significant ways in which lawmaking (both legislative and judicial) may be regarded as a form of prevention and the legal system may be used for prevention in the public interest. Although the chapter focuses on litigation and legislation of particular interest to those in the fields of mental health and mental retardation, the legal processes and principles described extend to many other areas of law with implications for promoting health and preventing harm.     

The Black Church and Family Support Programs

Abstract

The churches in the African American community have traditionally played many important supportive roles to families in many areas. Churches today are becoming more involved in the provision of services to the community members in response to many of the changes that are occurring in families, in employment, and in areas of increased poverty. Churches play important supportive roles by caring for children after school. Project SPIRIT is a program in which instructions are given in homework assistance, cultural continuity, African American history, and self esteem. These programs provide social support to all family members.