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Article

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

Indigenous populations have experienced hundreds of years of historical trauma, systemic racism, and oppression since colonization began in the Americas, Australia, and New Zealand. Settler colonialism has created and continues to perpetuate historical and ongoing trauma and systemic racism in Indigenous populations. Despite considerable diversity and resilience among Indigenous populations globally, there is a clear pattern of significant disparities and disproportionate burden of disease compared to other non-Indigenous populations, including higher rates of poverty, mortality, substance use, mental health and health issues, suicide, and lower life expectancy at birth. Substantial gaps related to access to healthcare and service utilization exist, particularly in low-income Indigenous communities. Implementation and sustainment of White dominant-culture frameworks of care in Indigenous communities perpetuate these systems of oppression. Development and implementation of culturally informed services that address historical trauma and oppression, and systematically integrate concepts of resiliency, empowerment, and self-determination into care, are issues of policy as well as practice in social work. The co-creation and subsequent implementation, monitoring, and sustainment of effective systems of care with Indigenous populations are essential in addressing health disparities and improving outcomes among Indigenous populations globally.

Article

Sangeun Lee

A pandemic contains three key components: extensiveness, novelty, and severity. For the past century, humankind experienced the Spanish flu in 1918 and COVID-19 in 2020 as major pandemics. The global impact has been extensive in terms of their origin, international transmission, and mortality rates. Public health measures to slow and stop pandemics have been implemented. During the COVID-19 pandemic, disparate impacts on health in different populations have been witnessed due to existing social inequalities, detriments of health, and structured racism. The interests of social workers have been adversely impacted in those pandemic times. Spanish flu bolstered social work with a professional presence. COVID-19 has confirmed the need for community engagement and community development to follow large-scale social policy reforms as a response to the disproportionate impact on diverse marginalized communities, which is the core of macro social work practice and would be more strongly called on to prepare for future pandemics.

Article

Janelle Stanley and Sarah Strole

The historical context of suicidal behavior and public policies addressing suicide arose simultaneously within the United States, and both reflect a culture of discrimination and economic disenfranchisement. Systems of oppression including anti-Black racism, restrictive immigration policy, displacement of American Indigenous communities, religious moralism, and the capitalist economic structure perpetuate high-risk categories of suicidality. Suicidal behavior, protective factors, and risk factors, including firearms, are examined in the context of twentieth and early twenty first century public policy. Recommendations for public policy will be discussed with consideration for policies that impact communities disproportionately and social work ethics, such as right to die laws and inconsistent standards of care.

Article

Stacy S. Remke

As a relatively new arena of practice, social work in pediatric palliative care (PPC) is evolving and being shaped by social work practitioners, as well as physician leaders, clinicians from other disciplines, and institutions. PPC practice requires a wide array of social work skills, knowledge, and insights to accomplish the many tasks and address the many issues that can arise when caring for children with life-threatening conditions. Family-centered, team-based care is the standard approach. Knowledge of childhood diseases, family systems, health care delivery, mental health assessment and interventions, child development, and bereavement care is required for best practice. The provision of effective care over time, across sites, and in the context of team-based specialty care requires skilled social work intervention.

Article

Hee Yun Lee, William Hasenbein, and Priscilla Gibson

As the older adult population continues to grow at a rapid rate, with an estimated 2.1 billion older adults in 2050, social welfare researchers are determined to fill the shortage of gerontological social workers and structural lag to best serve the baby boomers who are expected to need different services than previous generations. Mental illness impacts over 20% of older adults in the world and the United States. The major mental health issues in older adults include depression, anxiety, loneliness, and social isolation. Depression is considered one of the most common mental health issues among this population; however, the prevalence could be underestimated due to older adults linking relevant symptoms to other causes, such as old age, instead of as possible depression. Like depression, anxiety symptoms are often mistaken as results of aging. It is also difficult for providers to diagnose anxiety in this population due to anxiety frequently being coupled with other illnesses and the psychological stress that comes with old age. Because the presence of loneliness or social isolation can manifest depression and anxiety symptoms in older adults, it is also difficult to separate these two issues. With the anticipated increase of the older adult population within the next few years, measurement tools have been created to assess depression and anxiety specifically for older adults. In addition to adapting assessment tools, interventions tailored to older adults are essential to ensure treatment coherence, even though medications are the go-to treatment option.

Article

M. Aryana Bryan, Valerie Hruschak, Cory Dennis, Daniel Rosen, and Gerald Cochran

Opioid-related deaths by overdoses quadrupled in the United States from the years 1999 to 2015. This rise in mortality predominately occurred in the wake of historic changes in pain management practices and aggressive marketing of opioid medications such as oxycontin. Prescription opioid misuse and subsequent addiction spilled over to heroin and fentanyl for many. This drug epidemic differed from others in its impact among non-Hispanic whites, leading to drastic changes in how the United States views addiction and chooses to respond. This article offers an overview of opioid use disorder (OUD), its treatment and its relationship with pain. It also discusses special populations affected and provides insight into future directions for research and social work practice surrounding opioid management in the United States. Because of the profession’s emphasis on the person and social environment as well as its focus on vulnerable and oppressed populations, social work plays a critical role in addressing the crisis.

Article

The World Health Organization defines interprofessional collaborative practice (IPCP) as when multiple health workers from different professional backgrounds provide comprehensive health services working with patients/clients, families, caregivers, and communities to deliver quality health care across settings. IPCP has long been considered a best practice model to improve effective health-care delivery; however, implementation of collaborative practice models and evidence to support their efficacy have been relatively slow to develop. IPCP is inextricably linked to interprofessional education and practice (IPEP), which brings together students and practitioners across disciplines and practices, and includes direct care workforce, people/patients/clients, families, and communities to learn with, from, and about each other to prepare them for integrated workplace practice. The article will explore national and global interprofessional collaborative practice initiatives; outline core competencies and evidence for collaborative practice; provide examples of IPCP implementation; and discuss the role social work plays in the development and leadership of collaborative practice.

Article

Heather Larkin, Catherine LaBrenz, Stephen Oby, Beth Gerlach, Eunju Lee, Katharine Briar-Lawson, and Lisa Good

The adverse childhood experiences (ACE) study, including long-term health implications, is reviewed, followed by an overview of community approaches to addressing ACEs by building resilience in programs and communities. The restorative integral support (RIS) model embodies social work’s person-in-environment perspective and offers a framework to understand and respond to ACEs and their consequences. Social work’s role in addressing ACEs includes the importance of cross-disciplinary, interprofessional, and community-engaged strategies to enact community and system-wide change. Policy and practice implications to foster a culture of health and well-being are emphasized.

Article

Karen M. Sowers, Catherine N. Dulmus, and Braden K. Linn

In the 2010s, mental health and related issues such as suicide have become major global issues of public health concern. The indirect costs to the global economy of mental illness—encompassing such factors as loss of productivity and the spending on mental health services and other direct costs—amount to approximately $2.5 trillion a year. Global health experts and economists project this amount will increase to approximately $6 trillion by 2030. When gone untreated, mental illnesses account for 13% of the total global burden of disease. By the year 2030 it is expected that depression alone will be the leading cause of the global disease burden. Unfortunately, many persons suffering with mental illnesses do go untreated or receive marginally effective treatments. However, recent advances in technology, evidence-based treatments, and delivery systems of care provide hope for the world’s mentally ill population.