DISCUSSION 1:

The Aging Process

As individuals grow older, they experience biological changes, but how they experience these changes varies considerably. Senescence, or the process of aging, “affects different people, and various parts of the body, at different rates” (Zastrow & Kirst-Ashman, 2016, p. 658).

What factors affect the aging process? Why do some individuals appear to age faster than others? In this Discussion you address these questions and consider how, you, as a social worker, might apply your understanding of the aging process to your work with older clients.

To prepare for this Discussion, read “Working With the Aging: The Case of Francine” in Social Work Case Studies: Foundation Year.

Post a Discussion in which you:

o   Apply your understanding of the aging process to Francine’s case. How might Francine’s environment have influenced her aging process? How might you, as Francine’s social worker, apply your knowledge of the aging process to her case?

o   Identify an additional strategy you might use to apply your knowledge of the aging process to social work practice with older clients in general. Explain why you would use the strategy.

Be sure to support your posts with specific references to the resources. If you are using additional articles, be sure to provide full APA-formatted citations for your references

References

Plummer, S. -B., Makris, S., & Brocksen, S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].

Zastrow, C. H., & Kirst-Ashman, K. K. (2016). Understanding human behavior and the social environment (10th ed.). Boston, MA:  Cengage Learning.

Working With the Aging: The Case of Francine

Francine is a 70-year-old, Irish Catholic female. She worked for 40 years as a librarian in an institution of higher education and retired at age 65. Francine has lived alone for the past year, after her partner, Joan, died of cancer. Joan and Francine had been together for 30 years, and while Francine personally identifies as a lesbian, she never came out to her family or to her colleagues. When speaking to all but her closest confidantes, Francine referred to Joan as her “best friend” or her “roommate.” Francine’s bereavement was therefore complicated because she did not feel she could discuss the true nature of her partnership with Joan. She felt that there was little recognition from her family, and even some of her close associates, of the impact and meaning of Joan’s death to Francine. There is a history of alcohol abuse in Francine’s family, and Francine abused alcohol from late adolescence into her mid-30s. However, Francine has been in recovery for several decades. Francine has no known sexual abuse history and no criminal history.

Francine sought counseling with me for several reasons, including an ongoing depressed mood, a lack of pleasure or enjoyment in her life, and loneliness and isolation since Joan’s death. She also reported that she had begun to drink again and that while her drinking was not yet at the level it had been earlier in her life, she was concerned that she could return to a dependence upon alcohol. Francine came to counseling with several considerable strengths, including a capacity to form intimate relationships, a successful work history, a history of having maintained her sobriety in the past for many years, as well as insight into the factors that had contributed to her current difficulties.

During our initial meetings, Francine stated that her goals were to feel less depressed, to reduce or stop drinking, and to feel less isolated. In order to ensure that no medical issues were contributing to her depression symptoms, I referred Francine to her primary care physician for an evaluation. Francine’s physician did not find any medical cause of her symptoms, diagnosing Francine with moderate clinical depression and recommending that Francine begin a course of antidepressant medication. Francine was reluctant to take medication and first wanted to try a course of counseling.

In order to help Francine meet her goal of reducing her depression symptoms, I employed a technique called behavioral activation (BA), which is drawn from principles of cognitive behavioral therapy and helps to reengage people in pleasant physical, social, and recreational activities. We began with a small initial goal of having Francine dedicate at least 5 minutes of each day to an activity she found pleasant or rewarding. Over the following weeks, we increased the time. Francine’s treatment progress was monitored through weekly completion of the Patient Health Questionnaire (PHQ-9) in order to determine whether or not her depressive symptoms were improving.

I helped Francine address her drinking by reconnecting her with effective coping strategies she had used in the past to achieve and maintain her sobriety. These included identifying triggers for the urge to drink and exploring her motivations for both continuing to drink and for stopping her use of alcohol. Francine began attending regular meetings of Alcoholics Anonymous^™ (AA) and found several meetings that were specifically for older women and for lesbians. In addition, Francine spoke regularly with a sponsor who helped her to remain abstinent during particularly stressful moments during her reengagement in sobriety.

Finally, in order to address Francine’s goal of feeling less lonely and isolated, we explored potential avenues to increase her social networks. In addition to spending time with her family, friends, and her AA sponsor, Francine began to visit the local lesbian, gay, bisexual, and transgender (LGBT), center for the first time in her life and attended a support group for women who had lost their partners. Francine also began spending time at her local senior center and went there at least three times a week for exercise classes, other recreational activities, and lunch. She also began to do volunteer work at her local library once a week.

Over several months of counseling, Francine stopped drinking; significantly increased her daily involvement in pleasant and rewarding activities, including social and recreational activities; and reported feeling less lonely, despite still missing her partner a great deal. Francine’s scores on the PHQ-9 gradually decreased over time, and after 16 weeks of counseling, Francine reported that she no longer felt she needed the session to move on with her life. In addition, Francine visited her primary care physician, who found upon evaluation that her depression had lifted considerably and that an antidepressant was no longer indicated. By the end of counseling, Francine’s focused work on identifying her depression symptoms and her triggers for drinking equipped her to better recognize when she might need support in the future and to whom she could reach out for help if she needed it.

Discussion 2: Mental Health Care

Mental health care is a primary concern to social workers, who are the main providers of care to populations with mental health diagnoses. The system that provides services to individuals with mental health issues is often criticized for being reactive and only responding when individuals are in crisis. Crisis response is not designed to provide on-going care and is frequently very expensive, especially if hospitalization is involved.

Critics suggest a comprehensive plan, which involves preventive services, as well as a continuum of care. However, there are few, if any, effective and efficient program models. Social work expertise and input are vital to implementing effective services. Targeting services to individuals with a diagnosis of mental illness is one strategy. Another approach includes providing an array of services that are also preventative in nature. How might these suggestions address potential policy gaps in caring for individuals such as the family members in the Parker Family case?

For this Discussion, review this week’s resources, including the Parker Family video. Then consider the specific challenges or gaps in caring for individuals with a chronic mental illness might present for the mental health system based on the Parker case. Finally, think about how environmental stressors, such as poverty, can aggravate mental illness and make treatment more challenging.

·      Post an explanation of the specific challenges or gaps in the mental health care system for the care of individuals with chronic mental illnesses.

·      Base your response on the Parker case.

·      Then, describe how environmental stressors, such as poverty, can aggravate mental illness and make treatment more challenging.

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

References

    Popple, P. R., & Leighninger, L. (2015). The policy-based profession: An introduction to social welfare policy analysis for social workers. (6th ed.). Upper Saddle River, NJ: Pearson Education.

World Health Organization. (2004). Mental health policy and service guidance package: Mental health policy, plans and programmes. Retrieved from http://www.who.int/mental_health/policy/en/policy_plans_revision.pdf


Plummer, S. -B., Makris, S., & Brocksen, S. (Eds.). (2014). Sessions: Case histories. Baltimore: MD: Laureate International Universities Publishing. [Vital Source e-reader].

Parker Family Episode 5 Program Transcript

COUNSELOR: So you’ve been hospitalized, let’s see, four times altogether.

FEMALE CLIENT: Well actually, I should have only been in the hospital three times.

COUNSELOR: Why do you say that?

FEMALE SPEAKER: Well, on the third hospital visit they kicked me out before I was ready to leave. They said I was just in there to get away from my mom, but I told them they were wrong. My sister even backed me up on this. But they didn’t care. They just checked me out, and home sweet home I went. I was barely gone like a month and I was back in their monkey house. So technically, for me, hospital visits three and four are the same. I remember going back to that hospital seeing the same docs and nurses, and I just smiled and waved and said, see, I told you so. I mean, we picked up right where we left off.

COUNSELOR: What do you mean your sister backed you up?

FEMALE CLIENT: Jane, that’s my sister. Jane, she knew how crazy my mom is, so she took pictures of all that mess and all that junk my mom hoards, and she showed them to the social worker in the hospital.

COUNSELOR: What happened?

FEMALE CLIENT: You know what the social worker said? She said that there was nothing that she can do about it, that her job was to only make sure that patients have a place to go when they leave the hospital. Translation, when you’re out the door, good riddance and good luck. Some policy, huh?

Discussion 3: Emerging Issues in Mental Health Care

Like so many areas of practice in social work, mental health is dynamic and ever-evolving. Research continues to provide new information about how the brain functions, the role of genetics in mental health, and evidence to support new possibilities for treatment. Keeping up with these developments might seem impossible. However, being aware of and responsive to these developments and incorporating them into both your practice and social policy is essential to changing the lives of individuals and families who live with a mental health diagnosis and the impact it brings to their daily lives.

For this Discussion, review this week’s resources. Search the Library and other reputable online sources for emerging issues in the mental health care arena. Think about the issues that are being addressed by social policy and those that are in need of policy advocacy and why that might be the case. Then, consider what social workers can do to ensure that clients/populations receive necessary mental health services. Also, think about the ethical responsibility related to mental health care social workers must uphold in host settings when they encounter conflicts in administration and home values. Finally, search your state government sites for the mental health commitment standards in your state and reflect on the mental health services covered under your state’s Medicaid program.

·      Post an explanation of those emerging issues in the mental health care arena that the policymakers address and those that are in need of policy advocacy and why.

·      Then, explain what strategies social workers might use to ensure that clients/populations receive necessary mental health services.

·      Finally, explain the mental health commitment standards and mental health services in your state. In your explanation, refer to the services covered under your state’s Medicaid program.

Support your post with specific references to the resources. Be sure to provide full APA citations for your references.

References

    Popple, P. R., & Leighninger, L. (2015). The policy-based profession: An introduction to social welfare policy analysis for social workers. (6th ed.). Upper Saddle River, NJ: Pearson Education.

World Health Organization. (2004). Mental health policy and service guidance package: Mental health policy, plans and programmes. Retrieved from http://www.who.int/mental_health/policy/en/policy_plans_revision.pdf


Plummer, S. -B., Makris, S., & Brocksen, S. (Eds.). (2014). Sessions: Case histories. Baltimore: MD: Laureate International Universities Publishing. [Vital Source e-reader].

Mental Health America. (n.d.). Retrieved October 10, 2013, from www.mentalhealthamerica.net