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Article

Hospice  

Mary Raymer and Dona J. Reese

Hospice social workers are essential members of the interdisciplinary team that provide biopsychosocial and spiritual care to terminally ill patients and their significant others during the last 6 months of life. Hospice philosophy emphasizes symptom control, quality of life, patient self-determination, and death with dignity. Hospice social workers must be skilled in providing evidence-based interventions including direct client services; collaboration with the interdisciplinary team; community outreach; developing culturally competent services; and advocating for policy change on the organizational, local, and national levels.

Article

Saunders, Cicely  

Shirley Otis-Green

Dame Cicely Saunders (1918–2005) was the founder of the modern hospice and palliative care movement. As a nurse, social worker, and eventually a physician, she developed a systematic approach to studying the symptom management needs of the terminally ill.

Article

Health Care: Overview  

Colleen Galambos

This entry provides an overview of the state of health care in the United States. Service delivery problems such as access and affordability issues are examined, and health care disparities and the populations affected are identified. A discussion of two primary government-sponsored health care programs—Title XVIII (Medicare) and Title XIX (Medicaid), and the Patient Protection and Affordable Health Care Act—are reviewed along with various health care programs and major existing service delivery systems. Ethical conflicts in providing health care, and new directions and challenges are discussed, along with future roles for social workers.

Article

Collaborative Care  

Ellen Fink-Samnick

The past two decades have witnessed a surge in the growth of initiatives and funding to weave physical and behavioral health care, particularly with identification of the high costs incurred by their comorbidity. In response, a robust body of evidence now demonstrates the effectiveness of what is referred to as collaborative care. A wide range of models transverse the developmental lifespan, diagnostic categories, plus practice settings (e.g., primary care, specialty medical care, community-based health centers, clinics, and schools). This article will discuss the foundational elements of collaborative care, including the broad sweep of associated definitions and related concepts. Contemporary models will be reviewed along with identified contextual topics for practice. Special focus will be placed on the diverse implications collaborative care poses for the health and behavioral health workforce, especially social workers.

Article

Buddhist Chaplaincy  

Monica Sanford and Nathan Jishin Michon

Buddhist chaplaincy is a profession in which Buddhists with specialized training care for the spiritual needs of suffering individuals (careseekers), typically within non-religious settings such as hospitals, hospices, military, workplaces, or universities. Although the roots of spiritual care date back to the beginning of the Buddhist traditions, professionalized Buddhist chaplaincy is a very recent phenomenon. Despite some beginnings in the mid-20th century, most developments have occurred rapidly only within the 21st century. This contemporary movement is occurring in numerous places around the world, including North America, Europe, and Asia, covering a wide range of countries, cultures, and Buddhist traditions. The profession of chaplaincy was originally a Christian vocation but began expanding to serve the needs of multireligious careseekers and train caregivers of various religious backgrounds in the 20th century. Thus, while chaplaincy is now a profession open to all comers, including Buddhists, humanists, and atheists, many of the educational, training, and professional standards for certification or licensing are still normed against Christian expectations and legacy organizational structures, particularly in North America, Europe, and the British Commonwealth. In the countries where Buddhist chaplaincy is flourishing in the early 21st century, different groups are developing degree programs, training opportunities, and professional expectations that accord with their local regulatory bodies and other forms of existing chaplaincy certification. In Asian nations, Buddhists are stepping forward to build standards for providing spiritual care in the context of cultural institutions that are not typically religious (e.g., hospitals and schools). Diverse settings and differing requirements lead to distinctions between Buddhist chaplaincy in different countries. However, some of the core competencies for spiritual care are very consistent: compassion, listening, ritual proficiency, cultural understanding, and reflection. Buddhist and non-Buddhist chaplains alike agree to a fundamental skill set to care for people who are suffering in the various institutions where they work and volunteer. Distinctions between Buddhist and other forms of spiritual care are based on the care model employed, whether strictly co-religionist (i.e., Buddhists caring for Buddhists) or interfaith (i.e., Buddhists caring for all). In the latter case, professional chaplains (of any religion) are trained to provide spiritual care from the spiritual or religious worldview of the careseeker. As such, most Buddhist chaplains must possess basic knowledge and competency in many world religions. Nevertheless, Buddhist spiritual care may be distinct in its theory (Dharma based) and place more emphasis on mindfulness, meditation, and other contemplative techniques to benefit both careseekers and chaplains. Spiritual care that is “Dharma-based” means based on the teachings of the historical Buddha, Siddhartha Gautama, and/or the Buddhist traditions and teacher who followed after him. This includes a broad range of texts and teachings across the Buddhist world. As an emerging field, there is little literature on Buddhist chaplaincy, so it is currently somewhat difficult to say what theories and practices will come to dominate the profession.

Article

Foster Care  

Joyce E. Everett

Social work has long been involved in child foster care. Though its initial involvement de-emphasized the importance of infant–caregiver attachment, Bowlby’s theory of attachment is particularly relevant for child-welfare practice. This entry chronicles the history of child foster care and describes the evolution of legislation most pertinent for the provision of foster care. The characteristics of children in foster care since 2000 and the dynamic flow of children entering and exiting care are described. A brief account of foster care services and future trends in the field are highlighted.

Article

Terminal Illness  

Grace Christ

The ability of medical technology to prolong life over the past century has forced an examination of the experience and care of the dying. Many diseases that once were expected to follow a sloping illness trajectory with predictable deterioration and ultimately death are now more commonly experienced as chronic illnesses. They require more medical and other resources and challenge the family's ability to cope for much longer periods. The knowledge, value, and skill base of social work, and its broad range of practice sites make it uniquely suited to contribute to the movement to improve the care of the dying. The Social Work Hospice and Palliative Care Network were formed in 2007 to advance and give voice to social work's expertise in this area and to promote its development in practice, education, research, and policy.

Article

Kinship Care  

Carole B. Cox

Kinship care refers to the full time care, nurturing, and protection of children by relatives or others with a kinship bond to a child. Although such care is offered by many in relationships to children and is defined by states in many ways, the majority of kinship caregivers are grandparents. Among the primary reasons that children enter kinship care are parental substance abuse, neglect, abandonment, parental physical and mental illness, incarceration, domestic violence, and military deployment. Kinship care families tend to be poor with most caregivers outside of the formal service system. Consequently, they face many challenges as they struggle with policies and services that frequently are not responsive to their concerns. Social workers can play major roles in assuring that programs, which build upon the strengths of these families, are both available and accessible for them.

Article

Oncology Social Work  

Marie M. Lauria

Oncology social work is a specialization of social work in health care. Its practitioners provide supportive services and programs, patient navigation, education, research, administration, policy development, and advocacy to address the social, psychological, practical, and spiritual concerns of cancer patients, their families, and caregivers from pre-diagnosis through treatment, survivorship, and end of life care or bereavement. The coming decades will present many challenges and opportunities for oncology social workers in helping patients, families, and caregivers overcome barriers to quality of life and care.

Article

Deinstitutionalization  

Steven P. Segal

The deinstitutionalization policy sought to replace institutional care for populations in need of care and control with prosocial community-based alternatives. U.S. institutional populations, however, have increased since the policy’s inception by 205%. As implemented, with the assistance of advocacy and cost-cutting factions, it has succeeded only in enabling the divestiture of state responsibility for target groups. It sought to prevent unnecessary admission and retention in institutions. As implemented, deinstitutionalization initiated a process that involved a societal shift in the type of institutions and institutional alternatives used to house its target groups, often referred to as transinstitutionalization. For many in need of institutional placements, it has succeeded in preventing all admissions, while it has expanded admissions for others. In seeking to develop community alternatives for housing, treating, and habilitating or rehabilitating its target groups, it has succeeded in establishing a variety of alternative living arrangements and showcase/model programs illustrating what can be done, yet it has failed to deliver on investments in such programs to serve the majority of its target groups. It has resulted in the abandonment of substantial numbers to homelessness. Deinstitutionalization policy has motivated political, economic, legal, and social change in the care and control of six populations—older adults, children, people with mental illness, people with developmental disabilities, people under correctional system supervision, and, more recently, individuals without a home. A truer implementation of deinstitutionalization’s initial aspirations requires reconsideration of these changes.

Article

Deinstitutionalization in Macro Practice  

Steven P. Segal

The deinstitutionalization policy sought to replace institutional care for populations in need of care and control with prosocial community-based alternatives. U.S. institutional populations, however, have increased since the policy’s inception by 205%. As implemented, with the assistance of advocacy and cost-cutting factions, it has succeeded only in enabling the divestiture of state responsibility for target groups. It sought to prevent unnecessary admission and retention in institutions. As implemented, deinstitutionalization initiated a process that involved a societal shift in the type of institutions and institutional alternatives used to house its target groups, often referred to as trans-institutionalization. For many in need of institutional placements, it has succeeded in preventing all admissions, expanding admissions for others. In seeking to develop community alternatives for housing, treating, and habilitating or rehabilitating its target groups, it has succeeded in establishing a variety of alternative living arrangements and showcase and model programs illustrating what can be done; yet, it has failed to deliver on investments in such programs to serve the majority of its target groups. It has resulted in the abandonment of substantial numbers to homelessness. It has been documented, from political, economic, legal, and social perspectives, how this policy has affected the care and control of populations such as older adults, children, people with mental illness or developmental disabilities, people under correctional-system supervision, and, more recently, individuals without a home. Suggestions for a truer implementation of deinstitutionalization’s initial aspirations are available.

Article

Bioethics  

Larry W. Foster

Bioethics and biomedical ethics are defined. Common bioethical concepts, exemplary moral values, fundamental ethical principles, general ethical theories, and approaches to moral reasoning are reviewed. The scope of topics and issues, the nature of practice situations in bioethics, and social work roles on organizational bodies that monitor and respond to bioethical issues are summarized, as are trends in bioethics. Practice contexts, from beginning to end of life, are highlighted with biopsychosocial facts, ethical questions and issues, and implications for social work—a profession uniquely positioned in giving bioethics a social context.

Article

Family Caregiving  

Sandra Owens and Letha A. Chadiha

There is evidence that family caregiving in the United States has been increasing at an unprecedented rate as a result of various societal issues. This entry provides a summary of the scholarly literature regarding elder-caregiving trends, demographics, legislation, challenges, and racial and socioeconomic impacts, as well as the rewards of caregiving. Additionally, the entry provides empirical findings regarding evidence-based interventions associated with family caregiving of older adults.

Article

Kelly, James R., Jr.  

Sadye L. M. Logan

James R. Kelly, Jr. (1934–2002) undertook pioneering work in the development and administration of the Veterans Administration (VA) Extended Care programs that has basically shaped the modalities of long-term care now available to veterans across the United States.

Article

Adult Day Care  

Namkee G. Choi

Adult day care centers provide important health, social, and support services for functionally and cognitively impaired adults and their caregivers. The adult day care services are underutilized, however, because of the shortage of centers, caregivers' lack of awareness of and resistance to using services, and the mismatch between the needs of potential consumers and their informal caregivers and the services provided by the centers. To foster and support the expansion of adult day care centers, lessons learned from national demonstration programs need to be disseminated, and social workers need to be trained to provide essential services at the centers.

Article

End-of-Life Care Issues  

Linda P. Darrell

The perspective of end-of-life care has changed over the years. People are living longer, fuller lives due to advanced medical care and technology along with an increased interest in healthier lifestyles. The focus of end-of-life care has expanded to include accidental and sudden, unexpected death, chronic illness, anticipated death from longevity, and illnesses impacting children. An expanded perspective of end-of-life care must account for the challenges and changes of service delivery within a multi-cultural 21st-century milieu. The significance of advanced medical technology and improved lifestyles is an important component of a primary multidisciplinary assessment to understand the impact of such a life-altering occurrence as end-of-life care. Equally as important is a culturally inclusive perspective to accommodate the significance of longevity due to improved lifestyles, advanced medical technology, ethnicity, spirituality, and racial awareness. This article will explore the multiple concerns surrounding end-of-life care issues from an expansive worldview.

Article

Applying Anthropological Insight in an Aging World  

Sherylyn Briller and Erika Carrillo

Aging is a biological and sociocultural experience that occurs globally. Although aging is universal, ideas about aging and the life course vary widely and influence how aging and quality of life are perceived. Aging occurs both individually and collectively. Individuals have their own life stories and experiences shaped by cultural values, norms, and life course expectations. Anthropology’s attention to both scientific and humanistic ways of exploring what it means to be human is well suited to investigating how people live and age over time and in various locations. Like other anthropological subjects, one can explore aging in terms of human evolution as well as biological and cultural variation in aging experiences. Combining these topics to take a holistic perspective forms the subfield of the anthropology of aging. Given the breadth and scope of the anthropology of aging’s subject matter and global population aging, it is easy to see why this subfield is so fascinating to explore and work in as a career field. Numerous prior reviews cover the subfield’s origins and development and are highlighted. Homage is paid to the subfield’s history, and how to apply what has been learned to understanding a rapidly aging and socially changing world is discussed. As many have indicated, significant challenges and opportunities lie ahead.

Article

Pregnancy and Non-Sexually Transmitted Infections  

Ana Luiza Vilela Borges, Christiane Borges do Nascimento Chofakian, and Ana Paula Sayuri Sato

The focus on non-sexually transmitted infections during pregnancy is relevant, as they are one of the main causes of fetal and neonatal morbidity and mortality in many regions of the world, especially in low- and middle-income countries, respecting no national boundaries. While their possible vertical transmission may lead to adverse pregnancy outcomes, congenital rubella syndrome, measles, mumps, varicella, influenza, Zika virus, dengue, malaria, and toxoplasmosis are all preventable by measures such as vector control or improvement in sanitation, education, and socioeconomic status. Some are likewise preventable by specific vaccines already available, which can be administered in the first years of childhood. A package for intervention also includes adequate preconception care, routine antenatal screening, diagnosis, and treatment during pregnancy. Non-sexually transmitted diseases during pregnancy have different worldwide distributions and occasionally display as emerging or re-emerging diseases. Their epidemiological and clinical aspects, as well as evidence-based prevention and control measures, are relevant to settings with ongoing transmission or those about to be in vulnerable situations. Non-sexually transmitted infections are major public and global health concerns as potential causes of epidemics or pandemics, with numerous social, economic, and societal impacts..

Article

Preventing Falls Through Service Innovations: Institutional and Hospital Settings  

Keith Hill

Falls in hospital and residential care settings are common events that can have major impacts for the older person, their families, and staff and also at an organizational level. They are a major trigger event for those with chronic health problems to advance to greater levels of care because they often result in traumatic injuries while they provide a signal event for declining health that may have gone unobserved before injury. Falls among older people in hospital and residential care settings are often caused by a complex mix of risk factors and have proved difficult to prevent. There is growing research evidence that a mix of universal falls prevention interventions that are applied to all patients or residents, as well as targeted interventions addressing one or more identified personal and environmental falls risk factors (often based on a falls risk factor assessment and environmental assessment) can help to reduce risk of future falls in hospitals and residential care. Preventing falls among older people in hospitals and residential care settings requires a complete staff and organizational focus.

Article

Team-Based Health Care  

Michael A. Patchner and Lisa S. Patchner

The complicated nature of illness and health care delivery along with the complexity of insurance and health policy demand team-based health care. As a consequence, social workers have become engaged in team-based health care with numerous other professionals within multiple settings. Through the engagement of client-centered practice social workers experience systems that weigh the provision of direct services against macro quantitative accountability. This has resulted in newly defined roles and expectations for social workers who are well trained for both micro and macro practice. In multiple health care settings, social workers are partners in team-based models of care where patient-centered practice is a component within larger public and private delivery systems.