Intervention/treatment plan PTSD Veterans

Due Sunday January 12, 2020   by 6pm Central Time

  

Intervention/Treatment Plan Veterans Resilience Project

According to the Council on Social Work Education, Competency 4: Engage in Practice-informed Research and Research-informed Practice:

Social workers understand quantitative and qualitative research methods and their respective roles in advancing a science of social work and in evaluating their practice. Social workers know the principles of logic, scientific inquiry, and culturally informed and ethical approaches to building knowledge. Social workers understand that evidence that informs practice derives from multi-disciplinary sources and multiple ways of knowing. They also understand the processes for translating research findings into effective practice.

· Critically evaluate evidence based and “best practice” treatment interventions.

· Compose clinical intervention plans that are grounded research-based knowledge

This assignment is intended to help students demonstrate the behavioral components of this competency in their field education.

To Prepare: Review the agency’s intervention/treatment plan used to engage clients. 

After reviewing the Veterans Relicense Project’s intervention/treatment plan, consult the literature and conduct extensive research, with the goal of finding best practices that supports or adds to Veterans Resilience’s Project’s current intervention/treatment plan. The purpose of this assignment is to find research that supports or adds to the agency’s current intervention/treatment approach.

 Required Reading 

Min, J. W. (2005). Cultural competency: A key to effective future social work with racially and ethnically diverse elders. Families in Society, 86(3), 347–358.

AGENCY: VETERANS RESILIENCE PROJECT

https://www.resiliencemn.org/

Veterans resilience Project. (, 2019). What We Do. Retrieved from https://www.resiliencemn.org/ 

Treatment Plan EMDR Therapy that is practice at Veterans Resilience project, 12 Sessions.

Submit a 1-2 page paper in which you:

1. Briefly describe the Veterans Resilience Project intervention/treatment 

2. Briefly discuss best practices about interventions identified in the literature

3. Briefly discuss how the Veterans Resilience Project can incorporate those best practices into the current intervention/treatment plan 

4. Provide a brief summary of the similarities and differences between the intervention/treatment plan used at Veterans Resilience Project and the suggested practices in the literature

Cultural Competency: A Key to Effective Future Social Work With Racially and Ethnically Diverse Elders

Min, Jong Won

.

Families in Society

; Milwaukee

 Vol. 86, Iss. 3, 

(Jul-Sep 2005): 347-358. DOI:10.1606/1044-3894.3432

Abstract

Top of Form

Bottom of Form

With 2 dominant demographic imperatives of the aging population and increasing racial/ethnic diversity of the older population, current and future generations of racially and ethnically diverse elders are expected to experience complex and diverse sets of service needs. More than ever, the social work profession needs a strategic approach to working with current and future generations of diverse elders. The author presents information that allows a better understanding of future issues and problems facing racial/ethnic minority elders and discusses how social work can effectively and successfully address these future needs. Five specific recommendations are proposed: (a) reconceptualize race/ethnicity and diversity in social work practice, (b) identify and develop a conceptual framework for social work with racially and ethnically diverse elders, (c) consider a multidisciplinary community-oriented and neighborhood-based approach, (d) advance culturally competent gerontological social work with diverse elders, and (e) strengthen gerontological social work education with an emphasis on cultural competence.

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ABSTRACT

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ABSTRACT
With 2 dominant demographic imperatives of the aging population and increasing racial/ethnic diversity of the older population, current and future generations of racially and ethnically diverse elders are expected to experience complex and diverse sets of service needs. More than ever, the social work profession needs a strategic approach to working with current and future generations of diverse elders. The author presents information that allows a better understanding of future issues and problems facing racial/ethnic minority elders and discusses how social work can effectively and successfully address these future needs. Five specific recommendations are proposed: (a) reconceptualize race/ethnicity and diversity in social work practice, (b) identify and develop a conceptual framework for social work with racially and ethnically diverse elders, (c) consider a multidisciplinary community-oriented and neighborhood-based approach, (d) advance culturally competent gerontological social work with diverse elders, and (e) strengthen gerontological social work education with an emphasis on cultural competence.

Older people have been served by the profession of social work for more than the past half-century. Based on the ecological perspective, the goal of social work intervention with older people is to preserve or restore independence, promote optimal psychological and social functioning, and enhance quality of life through personal empowerment and effective service utilization (Schalach, Damron-Rodriguez, Robinson, & Feldman, 2000). Social work has also strived to meet the needs of underserved, oppressed, marginalized, and disadvantaged groups of older individuals, particularly those from racial/ethnic minority groups.

The social work profession, however, along with other professions such as medicine and nursing, faces great challenges in the coming years as a result of two major demographic imperatives: the projected rapid growth of the older population and increasing diversity of the older population with regard to race and ethnicity (Takamura, 2001; Torres-Gil & Moga, 2001). In 2000, 12.4% of the population was older than 65 years. This percentage is expected to increase to 16.3% by 2020 and to 20.7% by 2050 (U.S. Census Bureau, 2004). By 2050,25% of older Americans will be a member of ethnic or racial minority groups compared with 16.1% in 1999. According to the latest projected figures from 2000 to 2050 (U.S. Census Bureau, 2004), for the next 50 years, the “White alone” population will constitute the majority of those age 65 and older in the United States (Figure 1), although the proportion will decrease from 88.4% in 2000 to 77.5% in 2050. In terms of ethnic composition, the number of older people of any Hispanic origin will increase from 5.0% in 2000 to 27.8% of the total older population in 2050 (Figure 2). The number of non-Hispanic White elders is projected to decrease from 83.7% to 61.3% of the total older population during the same time period.

Based on racial categories suggested by the U.S. Census, the growth of non-White elders in number and proportion will be more rapid and drastic than that of White elders. The number of Black elderly persons (2.8 million in 2000) is expected to increase to 7.4 million by 2030 and to 10.4 million by 2050. The 1.75 million elderly Hispanics in 2000 will grow to 7.8 million in 2030 and to 15.2 million in 2050. During the same period, Asian elders will increase from 0.8 million in 2000 to 3.7 million in 2030 and 6.8 million in 2050 (U.S. Census Bureau, 2004).

The projected population percentage changes between 2000 and 2050 for each racial group are more revealing (Figure 3). Although the White-alone population aged 65 and older is expected to grow by 116.7%, other racial/ethnic groups are expected to increase by substantially greater margins: 262.1% for Blacks, 720.3% for Asians, 764.0% for Hispanics, and 553.4% for all other races (U.S. Census Bureau, 2004).

Such ethnic and racial shifts in population are of great significance in social work with older adults because race and ethnicity affect the status of elders in the community; perception and identification of health problems; quality and quantity of informal support; and patterns of use for health, social, and long-term care services (Kleinman, Eisenberg, & Good, 1978; Tripp-Reimer, 1999). Culture provides an important context from which we can better understand both issues faced by clients and their socially constructed behaviors. Equally important is the recognition that race, ethnicity, and socioeconomic status intertwine and interact to disproportionately influence the physical, functional, and psychological health of older adults. Nonetheless, relatively little attention has been directed to these issues in future social work, except by Takamura (2001), Torres-Gil (1992), and Torres-Gil and Moga (2001). Such lack of discussion of this issue may lead to a situation in which minority elders who are already at a disadvantage in terms of economic security and health will find themselves in much more dire circumstances.

Therefore, the primary aim of this article is to examine information that allows us to better understand future issues and problems facing racial/ethnic minority elders, to discuss how social work can effectively and successfully address the future needs of racial/ethnic minority elders, and to propose some direction and recommendations in preparing for future social work with diverse racial/ethnic minority elders. Toward this end, this article is organized into three major parts: (a) a brief overview of current, salient issues and problems facing diverse elders, (b) a discussion on future issues that are expected to accompany the population growth, and (c) a set of recommendations for future social work with diverse elders. This article does not intend to provide definitive answers to the many questions and challenges that lie ahead but rather serves as a starting point for discussion of the major ramifications of unprecedented demographic shifts on our ability to better serve diverse elders.

An Overview of Current Issues Faced by Diverse Elders

Although the heterogeneity of minority elders, both between and within groups, defies a quick generalization of issues and problems for all members of diverse racial-ethnic groups, there appears to be a set of issues common to diverse members of minority groups. The salient themes emerge around a lack of economic security and socioeconomic resources, higher rates of poverty, poorer self-rated health status, higher levels of physical and chronic conditions, and higher levels of mental-psychological issues. Yet older adults from racial/ethnic minority communities do not use appropriate services, whether it be health care, long-term care, or social services. Factors for such underutilization of services by minority elders are attributed to barriers to access the services in terms of language, lack of economic resources, cultural reasons, discrimination, and insensitivity of institutions toward minority elders.

Economic Security and Poverty

Economic hardship of the minority aged has been an important issue for both social policy and research, as evidenced by the double-jeopardy hypothesis from the 1970s (Dowd & Bengston, 1978), which states that the minority aged face a double burden of being older and being members of a racial/ethnic minority. Although the hypothesis was not fully supported by empirical data, it still holds an intuitive appeal to understanding and conceptualizing economic plights of the minority aged. In 2003, about 1 of every 10 older individuals aged 65 and older in the United States (10.2%) lived in poverty (DeNavas-Walt, Proctor, & Mills, 2004). However, a breakdown of poverty status by racial and ethnic groups paints quite a different picture with regard to the economic status of the older population. Although only 1 of every 13 non-Hispanic White elders (8.0%) lived in poverty, substantially higher proportions of some racial/ethnic elders lived in poverty: 23.7% for Black alone, 14.3% for Asian alone, and 19.5% for Hispanic elders. Economic disparities appear to persist despite social policies and programs aimed at improving the economic conditions of minority elders. Furthermore, it has been argued that minority elders have not benefited directly from such policy efforts (Angel & Angel, 1997; Villa, 1998; Wallace & Villa, 1997) and have been overlooked in aging social policy and programs. In addition, older people from racial and ethnic minority groups are especially dependent on government safety-net programs (Binstock, 1999).

Economic Security and Poverty
Economic hardship of the minority aged has been an important issue for both social policy and research, as evidenced by the double-jeopardy hypothesis from the 1970s (Dowd & Bengston, 1978), which states that the minority aged face a double burden of being older and being members of a racial/ethnic minority. Although the hypothesis was not fully supported by empirical data, it still holds an intuitive appeal to understanding and conceptualizing economic plights of the minority aged. In 2003, about 1 of every 10 older individuals aged 65 and older in the United States (10.2%) lived in poverty (DeNavas-Walt, Proctor, & Mills, 2004). However, a breakdown of poverty status by racial and ethnic groups paints quite a different picture with regard to the economic status of the older population. Although only 1 of every 13 non-Hispanic White elders (8.0%) lived in poverty, substantially higher proportions of some racial/ethnic elders lived in poverty: 23.7% for Black alone, 14.3% for Asian alone, and 19.5% for Hispanic elders. Economic disparities appear to persist despite social policies and programs aimed at improving the economic conditions of minority elders. Furthermore, it has been argued that minority elders have not benefited directly from such policy efforts (Angel & Angel, 1997; Villa, 1998; Wallace & Villa, 1997) and have been overlooked in aging social policy and programs. In addition, older people from racial and ethnic minority groups are especially dependent on government safety-net programs (Binstock, 1999).

Economic security is said to be a three-legged stool consisting of Social Security, pensions, and personal savings. Many minority elders depend heavily on Social Security and receive little support from private pensions and even less income from accumulated assets (Chen, 1999). Social Security as an income source is more important for Black and Hispanic elders than for Whites. It represents 42% and 45% of their total income, respectively, compared with 40% for Whites. Private pensions have not become a significant source of retirement income for a large number of minority elders (Chen, 1999).

Health

Central to understanding current health status of minority elders is persistent racial-ethnic disparities with regard to health outcomes, indicating higher rates of mortality, disease, or disability. Minority elders are disproportionately at a disadvantage with various health outcomes compared with non-Hispanic White elders (Johnson & Smith, 2002; U.S. Department of Health and Human Services, 2003). Elderly Black Americans have a higher incidence of hypertension, heart disease, stroke, and end-state renal disease than their non-Hispanic White counterparts (Jackson & George, 1998). Black Americans, Hispanics, and Native Americans are disproportionately affected by Type 2 diabetes (Harris, Hadden, Knowler, & Bennett, 1987). In addition, minority elders experience barriers to health services and lack of knowledge about the diseases. This may result in a more rapid decline in functional status. For example, Black Americans aged 65 to 74 have an 80% risk of being disabled (Cohen, 1993). Although age is a potent risk factor for most chronic diseases and impairments, economic resources and socioeconomic status can influence the severity of disease or delay its onset (Binstock, 1999; Schonebaum & Waidman, 1997; Smith & Kington, 1997). In particular, older women with poverty and near-poverty incomes have higher rates of chronic disease than similarly aged men, and the management of their burden is further complicated by limited economic resources (Miles, 1999). Low socioeconomic status is associated with a reduced level of access to medical care and poor health status (Ford & Hatchett, 2001).

Reports by the Institute of Medicine (2002) and the Commonwealth Fund’s 2001 Health Care Quality Survey (Collins, 2001) indicated that racial and ethnic minorities in the United States receive a lower quality of care for both acute and chronic diseases than Whites, even when accounting for differential access to care. Despite many practice and policy efforts made to address such disparities, inequality persists in health status and access to health care among racial/ethnic groups in the United States (U.S. Department of Health and Human Services, 2003). For example, Asian Pacific Islanders were more likely to be subject to physical restraints in nursing homes compared with non-Hispanic Whites, and more elderly Asians than elderly Whites reported having difficulty in understanding health care information provided by their physicians (55% and 47%, respectively). Chadiha, Proctor, Morrow-Howell, Darkwa, and Dore (1995) found that race was a significant predictor of receipt of both formal and informal care among African American and White elders. In their study, African Americans received significantly fewer hours of formal posthospital home care per week than did White elderly, and the formal care they did receive was inadequate.

Mental Health

Approximately 20% of Americans aged 55 and older experience specific mental health disorders not part of the normal aging process. Common disorders in general include anxiety disorders, such as phobias and obsessive-compulsive disorder; cognitive impairment, including Alzheimer’s disease; and mood disorders, such as depression. However, older adults underuse mental health services because of a lack of awareness and education about mental health disorders as well as stigma and shame associated with mental illness. These issues are more pronounced among minority elders (Braun & Browne, 1998; Braun, Takamura, Forman, & Sasaki, 1995; Browne, Fong, & Mokuau, 1994; Padgett, 1995; Torres, 1999). Approximately one third or more of older Hispanics speak English poorly or not at all, ranging from 32% for Mexican American elders to 63% for Cuban American elderly (Mutchler & Brallier, 1999), and approximately 60% of Asian elderly in the United States have limited English proficiency (Min & Moon, in press). According to the U.S. Surgeon General’s 1999 report, however, few mental health service providers have bilingual professionals who can address limited English proficiency of older minority clients (U.S. Department of Health and Human Services, 1999).

Service Use and Barriers to Access Services

Minority elders use long-term care services less frequently than their non-Hispanic White counterparts, even when controlling for their higher level of functional limitation (Damron-Rodriguez, Wallace, & Kington, 1994; Mui & Burnette, 1994; Wallace, Campbell, & Lew-Ting, 1994; Wallace, Levy-Storms, Kington, & Andersen, 1998). Their underuse of services was associated with cultural norms, strong family and community networks, discrimination, and barriers to access services resulting from language and low socioeconomic status (Belgrave & Wykle, 1993; Mui & Burnette, 1994; Wallace, 1990; Wallace et al., 1994, 1998). Studies have shown that minority elders are also underrepresented in nursing homes. Such disproportionate underuse of available residential long-term care facilities by minority elders was attributed to institutional barriers (Wallace, 1990; Wallace et al., 1994). For the Hispanic elderly, such barriers include racial discrimination, high cost, insensitivity to cultural customs, and language problems. Furthermore, limited English proficiency affects the understanding between health professionals and Hispanic elderly patients (Torres, 1999), which may in turn harm effective intervention and service provision. Jones (1999) reported that Black elders experience barriers to access health care services, lower rates of health service use rates, higher morbidity rates, poverty, and lower educational level. These barriers are compounded with age discrimination and racism.

Family and Social Support

Traditionally, family has been a major source of emotional and instrumental support for older adults regardless of race. Nevertheless, minority elders are known to have enjoyed greater social networks and support in the extended family structure than their non-Hispanic White counterparts. However, because of access barriers experienced by minority elders, their families become the primary caregivers and provide support to a substantially greater extent than for White elders. Often, informal support by family and relatives serves as a coping mechanism for dealing with barriers to access services. Social support from informal sources can help to alleviate or mitigate the negative impact of disease and disability on overall well-being (Blazer, Hays, Fillenbaum, & Gold, 1997; Cohen, 1993). Miller and Stull (1999) reported that African American spouse caregivers of persons older than 60 with coresidence and a diagnosis of dementia reported that they were less likely to endorse the use of community services, preferring to ask for help from family or friends, to maintain independence from the service system because of distrust that the community service staff or workers will provide adequate care. With regard to living arrangement, approximately half of the elderly in each racial/ethnic group, except Blacks, lived with a spouse. Whereas one third of elderly Blacks and non-Hispanic Whites live alone, Hispanics and Asian Americans live alone to a lesser degree. For Blacks, living alone and living with others (i.e., without a spouse) are both as common as living with a spouse (Siegel, 1999).

However, despite the centrality of family in the lives of minority elders, each racial/ethnic group has a somewhat different family structure owing to its historical experiences and cultural norms (Dilworth-Anderson & Burton, 1999). For example, for African American families, because the practice of prohibiting African Americans from using resources to facilitate their individual and family well-being has continued even after the legal abolishment of Jim Crow laws in the mid-1960s (Jaynes & Williams, 1989), the family and church play greater roles in providing formal support and assistance (Lincoln & Mamiya, 1991).

Connell and Gibson (1997) reported that coping strategies used by dementia caregivers differ between Black and White caregivers. White caregivers were more likely to attend support groups and receive help from professionals, whereas Black caregivers were much more likely to use prayer, faith, or religion as coping strategies. The definition of contemporary African American families includes family members, fictive kin, and friends. Family boundaries are permeable and flexible, and family functioning is primarily based on an extended-family model. As for Hispanic Americans, family-centered culture serves as the core of their social support system. Hispanics are strongly rooted in family affiliation; they live in close proximity to each other, which facilitates caring for children and older family members. In Hispanic American families, great variations in family boundaries are found as follows: Puerto Ricans are more likely than both Cubans and Mexican Americans to include nonblood kin (e.g., friends) in their family. Friends are not family in Mexican and Cuban American families. Finally, families of Asian Americans also operate within an extended-family model and provide family-centered social support in emotional, financial, and instrumental aspects, as with Hispanic American families. However, extended familism is maintained by strict gender norms and rules that regulate who gives care to elderly family members. Shame and harmony help maintain family norms and shape their support systems.

What Are Future Needs and Issues for Minority Elders?

Often described as the “gerontological explosion” by Siegel (1999), the projected sharp growth of the older population and increased minority elders in proportion and number (Siegel, 1999) put pressure on society and on helping professions, including social work, to better deal with both existing and newly emerging needs of the minority elderly population. It appears that we know more about the size and magnitude of the growing minority elderly population than the nature of issues and challenges confronting it. Nevertheless, two major groups will comprise future generations of older adults: (a) the current older population moving into advanced age and (b) the entry of the middle-aged population into the 65-year and older bracket. Given the two different groups joining the 65+ age group, the needs of future minority elders will be very divergent, distinct, and complex, presenting enormous challenges to the field of social work and testing our ability to respond to their needs. It is conceivable that future generations of minority older adults, primarily the current middle-aged population, will benefit from greater opportunities that were not available for previous generations, such as education, careers, retirement plans, and acculturation (Torres-Gil & Moga, 2001). It is also likely that they may age into poorer health and fewer available economic resources than their non-Hispanic White counterparts. Another source of diversity and heterogeneity would be a different composition of each racial/ethnic group with regard to immigration history and national-origin groups. For example, the aging of recent immigrants is expected to play a major role in the growth of the Hispanic elderly population in the future (Siegel, 1999). Also, the Asian elderly population will consist of three groups: those Asians who came to this country as young persons early in the 20th century; the children of these immigrants; and those Asians who came to the United States after changes in the immigration law of 1965 (Siegel, 1999).

Although it remains to be seen what new challenges will emerge with future generations of minority elders, the following issues are expected to demand further exploration: faster growth of the oldest-old age group (85+ years), economic insecurity, health (i.e., chronic dis eases and long-term care), and living arrangement. In general, research indicates that among the three old-age groups-young-old (65-74), old-old (75-84), and oldest old (85+)-the oldest-old group represents the highest service needs in terms of morbidity, comorbidity, living alone, poverty, and risk of institutionalization. It is projected that from 1995 to 2050 the greatest relative growth among the minority elderly population is expected to occur for those at a very advanced age (85+): 10% to 20% by 2050 (Siegel, 1999). As mentioned, ethnic minorities are at greater risk of economic insecurity in late life than their non-Hispanic White counterparts. When minority baby boomers begin to reach old age, Binstock (1999) speculated that there is little to indicate that they will be less in need of governmental assistance (e.g., Supplemental Security Income) than the current cohort of minority elders. Furthermore, a disproportionate number of these persons are likely to enter advanced age with few assets and low incomes to provide for their needs. Future older minorities will continue to rely, to an overwhelming degree, on Social Security in their retirement years (Chen, 1999). When minority baby boomers reach old age, it is expected that they will suffer from comparatively higher rates of diseases and disability than non-Hispanic White elders (Kiyak & Hooyman, 1994) as a result of the continuing trend of barriers to access to health care and high-risk employment and social environments earlier in life. In addition, increases are expected in the propensity of minority elders to live alone as well as a further increase in female-headed households among Blacks and Hispanics (Worobey & Angel, 1990). Therefore, the minority elderly population of the future will include a disproportionate share of the most needy persons, particularly among those living alone and those of advanced age, and, therefore, will require a disproportionate share of formal support (Siegel, 1999).

These concerns about the future of minority elders were also expressed by the American Association of Retired Person’s (1995) Minority’s Affairs, which predicted that the status of older minorities is not likely to improve greatly in the immediate future, and factors such as education, employment, income, and health will not improve much among minority populations now approaching retirement age.

Is Social Work Ready for Future Generations of Racially/Ethnically Diverse Elders?

“What does that mean for gerontological social work?” was a question raised by Torres-Gil and Moga (2001) in response to the projected demographic shifts and diversity of race, ethnicity, culture, and socioeconomic status among current and future generations of minority elderly. Certainly, they present both opportunities and challenges not only to require the social work profession to have a greater understanding of population aging and its long-term consequences but also to reassess the relevance of existing social work fields for meeting the needs of current and emerging populations of minority elders. The profession of social work is increasingly called on to articulate the policy agenda and alternatives, which will inevitably affect social work practice (Takamura, 2001).

More importantly, another question is posed: “Is social work both able and prepared to address future generations of diverse minority elderly?” Answering this question requires a serious look at multiple dimensions of the social work profession in terms of current social work practice, social work education and training, and the workforce. The profession of social work turns its attention to its ability to effectively respond to and deal with the growth of the older population (Rosen & Zlotnik, 2001). Social work with older people has played an important role in maximizing the potential of individuals to function independently as well as in providing services by linking individuals to social institutions, organizations, and agencies (Lowry, 1985; Schalach et al., 2000).

Although some interventions have preventive objectives of helping older adults with physical, psychological, and social functioning, other intervention approaches are remedial, with the goal of restoring functioning impaired by a health crisis and significant life events (e.g., loss of spouse and onset of chronic health problem; Kropf, Cummings, & Sukumar, 1998). Social work interventions are also provided in a wide range of settings, such as home, community, adult day care centers, hospitals, and nursing homes (McInnis-Dittrich, 2005). Social workers address various issues and problems faced by older adults: physical, psychological, mental, and social (e.g., coping with health symptoms, dealing with emotional and psychological conditions, dealing with difficulties with grief and bereavement, encouraging social activity, and adjusting to new environments) and assessment, community resource expertise, advocacy, and case management (Howe, Hyer, Mellor, Lindeman, & Luptak, 2001).

In principle, the social work profession is well positioned to advance our ability to address diverse needs of future generations of minority elders because of its long-standing commitment to getting to the heart of matters of oppression, marginalization, and social isolation. In reality, however, although the demand for social work services with the older population will increase through 2020 (Klein, 1998), it has been pointed out that social work may not be adequately prepared for the aging society (Schalach et al., 2000) and social workers are not adequately trained to handle the complexities of older people’s needs (Schneider, Kropf, & Kisor, 2000). Hudson, Gonyea, and Curley (2003) reported that only 5% of social workers identified themselves as primarily working with the older population. This considerable gap is attributed to a lack of social work education in aging in undergraduate and graduate social work programs and a small number of students interested in working with older adults. Given the current status of social work with older adults, the situation in social work with minority elders is bleak, raising concerns about whether the social work profession is both able and prepared to effectively serve the population. A wider and deeper gap between the realities of minority elders and the profession’s ability to address the complex needs at multiple levels of practice settings and diverse subpopulations would be a plausible scenario.

Discussion

The projected growth of the older population, resulting from the aging of the baby boomer generation and rapid diversification of the older population in terms of race and ethnicity, is an unprecedented sociodemographic phenomenon in this country. Yet little is known about or can be predicted by the nature of the future. The unknown and ambiguous nature of the future makes it very challenging to be adequately prepared for racially/ethnically diverse older individuals and the host of issues they will confront. In this article, I attempted an educated guess of what future generations of racially/ethnically diverse older individuals will face, based on both the numerical projection and a review of major challenges and issues identified in the past and recent literature. The numerical projection is only a starting point for our understanding and for a plan for future. The numbers do not tell everything. Changing demography alone will not influence public policy (Wallace & Villa, 1997) or improve our ability to address the complex needs of diverse elderly population in the future. Nevertheless, it is important that we recognize what lies ahead and take more strategic and proactive approaches to addressing their complex and diverse needs in the future.

The profession of social work has long been committed to and engaged in helping minority elders with their countless challenges. In fact, social work does not have any choice but to be both able and ready for the future generation of minority elders. In this context, Takamura (2001) urged that economic security of an aging population, affordable access to health care, and assistance to families with their caregiving responsibilities should be given policy and practice priorities. However, as Binstock (1999) cautioned, the current political climate that focuses on social program retrenchments and changes made under personal responsibility may be unfavorable to such priority areas. More efforts will be made to minimize the role of government by reducing spending on social and health programs and raising eligibility criteria for such programs (Congressional Budget Office, 2004), thereby shifting the burden of care onto individuals and family members and opening doors for privatization, as hinted by the most recent attention to the possible reform of Social Security by introducing private investment accounts.

In light of the demographic and sociopolitical context, it is clear that a stronger commitment by the social work profession to develop and provide culturally competent services and reevaluate the ability and preparedness of the social work profession is needed more than ever to deal effectively with current and future generations of racially and ethnically diverse minority elders. Although the social work profession attempts to respond to issues and challenges of minority elders in a proactive and preventive manner, it may be sometimes reactive or remedial, in part because of its reliance on social policy and existing practice paradigm. In most cases, social work practice follows social policy rather than leads the formulation and development of policy. Many action can and should be taken, however, to better respond to future needs of minority elders. A strong interest and support for various gerontological/geriatric social work initiatives (e.g., the John A. Hartford Foundation) need to be continued to improve gerontological social work competency of social work students and faculty, with cultural competency being an important part of future development. At the same time, more opportunities for continuing education of current social workers should be available not only on gerontology itself but also on issues related to racial/ethnic minority elders and cultural competency (e.g., Boston University’s Institute of Geriatric Social Work). In addition, we need to learn more about the plight and challenges confronting current and future needs of minority elders through rigorous gerontological social work research and to better translate what we learn through research into effective social work practice. Finally, cultural competency should serve as an effective means, not an end itself, to addressing the needs of minority elders in social work. Quality of life, improved physical and psychological functioning, and independence should be regarded as overarching social work goals in a color- or race-neutral manner, but achieving these goals may require color-specific or culturally sensitive means and ways. Cultural competency is achieved not only with “speaking the same language” but with a combination of cultural sensitivity, awareness, accurate knowledge and understanding, and skills.

Recommendations for Social Work Practice

A plethora of important issues and challenges are likely to engender new hardships for many minority elders, ranging from persistent health disparities in medical/health care, long-term care (Alecxih, 2001; Mui, Choi, & Monk, 1998), mental health (Padgett, 1995; Torres, 1999), chronic disease management (Jones, 1999), family caregiving, spiritual issues, hospice/end-of-life care, dementia care, and grandparenting (Burton, 1992; Minkler & Fuller-Thompson, 2000), to name a few. A strong policy effort to reduce and even eliminate health disparities for racially/ethnically diverse populations in the United States should be continued to address structural barriers. I conclude with the following five recommendations, with a view to setting some priorities for further dialogue and discussion on future social work practice with racial/ethnic minority elders.

First, how should race/ethnicity and diversity be treated in future social work practice (Capitman, 2002)? Torres-Gil and Moga (2001) argued that the demographic shift and increasing diversity of the older population will require social workers to rethink issues of diversity and to move beyond generalized notions of race. Race/ethnicity could be an asset to the profession if we begin to take steps to better understand the complexities of needs and issues and to engage in culturally competent practice. On the other hand, race/ethnicity would be a liability if we cannot respond to the complex and diverse needs of minority elders in a culturally competent manner. Future service and care needs would become amplified and more complex than the current ones, further widening the already wide service gap. The race or ethnicity in gerontological research has been regarded as a single mark-up variable (La Veist, 1995), expecting that it would represent cultural belief, attitudes, preferences, and lifestyles. Often used as a control variable, such practice unintentionally masks important within-group heterogeneity of any given racial/ethnic group. A similar phenomenon takes place in social work practice, where a question on either an intake form or an assessment form asks about racial/ethnic background, which sometimes will not get appropriately considered in social work assessment, intervention, or evaluation.

Second, the social work profession should identify and develop a conceptual framework for addressing race/ethnicity as a main focal point. In social work, an ecological perspective (Germain & Gitterman, 1980) has been a dominant approach in understanding issues and problems within the context of person-in-environment and guiding social work interventions designed to enhance the fit between the person and the environment. In the field of gerontology, other frameworks have been put forth to facilitate understanding of older adults and their social environments. Examples include the life course perspective (George, 1996) and the successful-aging approach (Kahana et al., 1999; Rowe & Kahn, 1997). Although these existing frameworks serve to better elucidate the plight of minority elders, they lack specific articulation on how race/ethnicity affects the aging process, perception of illness and disability, help-seeking behaviors, family dynamics, decision making, and autonomy. Specifically, the value of the profession as indicated in the Code of Ethics of the National Association of Social Workers (NASW; 2000; NASW Code of Ethics), emphasizing the right of self-determination of the individual, may not be consistent with other cultures. Self-determination can instead suggest a feeling of being alone and without help (Pinderhughes, 1983). The guiding principles of the social work profession may conflict with the values of the groups we seek to serve (Cox & Ephross, 1998). In addition, growing attention has been directed to the issues of autonomy and care preference among minority elders (Blackball, Murphy, Frank, Michel, & Azen, 1995; Kagawa-Singer & Blackhall, 2001; McCormick et al., 1996; McLaughlin & Braun, 1998; Min, 2005). The studies provide insight into incongruence between current health/legal practices and culturally shaped decision-making styles of minority elders. It is a very important area in which social workers should demonstrate sensitivity and competency. Finally, we must also incorporate cultural factors in the assessment, intervention, and delivery of social work services. An example of this effort comes from Cox and Ephross (1998). In their attempts to directly deal with race and ethnicity issue in social work practice, they proposed the ethnic lens model of social work practice. Cox and Ephross noted that the ecological perspective (Germain & Gitterman, 1980) in social work practice may be limited in addressing problems of ethnic minority persons who are deeply rooted in cultural values, beliefs, and attitudes. The ethnic lens model, in contrast, considers ethnic identification and membership as providing lenses through which members and ethnic groups perceive experiences. All lenses used by ethnic group members and those used by members of the greater society are shaped by cultural meanings, values, attitudes, and experiences. The lens is fundamental to understanding the ways in which ethnicity affects social work practice. This model may allow the social work profession to adopt cultural sensitivity and competency as a major focus of practice with minority elders.

Third, it is recommended that the social work profession give more serious consideration to a multidisciplinary community-oriented and neighborhood-based approach when addressing the unique needs of minority elders. Older adults with various needs, regardless of their racial/ethnic backgrounds, would be best served in a multidisciplinary setting because of the biopsychosocial nature of their issues and challenges in old age (McInnis-Dittrich, 2005). However, it appears that the multidisciplinary approach is by and large limited to medical settings and is not extended to community settings. Using the community as an anchor point for service delivery would provide more opportunities to make programs and services more indigenous to culture. A case in point comes from lessons learned from the On-Lok program in the Chinatown area of San Francisco, which has integrated a full continuum of multidisciplinary acute and chronic care into one agency within the context of the community. Its demonstration program, PACE (Program for All-Inclusive Care for the Elderly), has been established as a Medicare provider by the Balanced Budget Act of 1997, based on their positive outcomes. The On-Lok program has shown that it can be both a fiscally efficient and quality-ensuring way of serving elders. A close examination of the On-Lok experience, at least in its earlier times, informs us that one of the keys to their success lies in the effective use of a community and neighborhood-based approach. It has made the best use of the strength and resources available in the community in providing effective services to ethnically diverse elders. Many racial/ethnic minority groups in the United States have formed ethnic enclaves such as Chinatown, Koreatown, Little Tokyo, Little Saigon, and so on, where they gather for multiple levels of social functions (i.e., religious organization, commerce, social participation), developing another small society within the larger society. Although it may isolate some minority group members from the mainstream society, the enclave serves as a comfortable social environment for many minority elders. It is important for social workers to recognize the strengths of existing communities, to develop relationships with community leaders, and to build strong community support and service structures that would better serve the needs of minority elders.

Fourth, it is recommended that the field of social work put cultural competence into action. The social work profession’s strong commitment to cultural competency is reflected in Fong and Furuto (2001), Lum (2003), the NASW Code of Ethics (NASW, 2000), and NASW (2001) Standards for Cultural Competence in Social Work Practice. NASW (2001) defines cultural competence as

The process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each. (p. 11)

With larger numbers of ethnic minority elders, culturally appropriate and competent social work services will be in even greater demand than ever before. Cultural competency increases our ability to understand strengths, as well as problems, of minority elders and allows us to serve them and address the situation more effectively, thereby enhancing their quality of life. Culturally competent social work practice is more important for racially/ethnically diverse minority elders, particularly those with debilitating chronic conditions, functional limitations, and negative life events (i.e., loss of a spouse), than for any other age group. The minority elders, for example, in residential care facilities (i.e., assisted-living facilities and nursing homes), would prefer to receive care in a culturally comfortable manner and setting in terms of language, food, and surroundings (Min, 2001). Nevertheless, despite the profession’s commitment to cultural competence, it is not clear to what extent cultural competence has been actually applied in social work practice with racially/ethnically diverse minority elders. Ethnocentric or culturally encapsulated services that may result from lack of knowledge, understanding, and skills result in underuse, dissatisfaction, premature termination, and poor practice outcomes (Tripp-Reimer, 1999). Cultural competence could play a major role in reducing racial/ethnic health disparities (Brach & Fraserirector, 2000) and as such may be a key to addressing future needs of racial/ethnic minority elders.

Two examples of existing social work intervention or service can be used to further illustrate the importance of cultural competence for effective social work practice with racially/ethnically diverse minority elders. First, with respect to the On-Lok program mentioned previously, what is more important to our consideration of future social work with racial/ethnic minority elders is its attention to cultural awareness and cultural competency as an organizational commitment (Kornblatt, Eng, & Hansen, 2002). The organization’s awareness and sensitivity to cross-cultural aspects of care in addressing ethnically diverse needs of program participants are very conducive to ensuring quality of care and enhancing quality of life for the participants. A careful examination of how the On-Lok program serves ethnically diverse elders in a culturally sensitive way is needed in light of minority elders’ propensity to underuse institutional/residential care as a result of multiple barriers to accessing services. Second, the Cross-Cultural Senior Mental Health Program is one of many programs offered by the Senior Community Center of San Diego, which primarily serves low-income and homeless seniors from ethnically diverse backgrounds (e.g., African Americans, Mexican Americans, Filipino Americans). Funded by the California Endowment, the Cross-Cultural Senior Mental Health Program was innovative and successful in reaching out to and serving traditionally hard-to-reach populations of low-income and homeless seniors with mental health conditions of depression and anxiety. It was also given recognition as a “Local Best Practice” by the Gerontological Society of America in 2003. The strength of the program was that social work assessment and intervention was based on “cultural buy-ins” from the clients by starting at the level where they are and by paying special attention to their own understanding and perspectives of issues, needs, service goals, and preferred approaches to achieving the goals. The cultural buy-ins were sought by an interdisciplinary team consisting of a psychiatrist, a psychiatric nurse, and a social worker, all of whom were bilingual and bicultural.

In sum, for effective social work intervention with racial/ethnically diverse elders, it is important to recognize that language barriers may hinder the social worker-client relationship and cross-cultural understanding and communications. Social workers working with clients with limited English proficiency and a different cultural/ethnic background different from their own should consider seeking help from an ethnic consultant (Takamura, 1991) or cultural broker (Valle, 1998) to ensure effective communication. Furthermore, it is suggested that social workers also identify and evaluate cultural influences in clients by using frameworks such as Koenig and Gates-Williams’s (1995) Attitudes, Beliefs, Context, Decision Making, and Environment (ABCDE), later adapted by Kagawa-Singer and Blackhall (2001), or Valle’s (1998) Cultural Mapping Process. Also, it is crucial that social workers be sensitive to the needs for and open to the use of screening and assessment tools that are validated as culturally and linguistically appropriate (Tran, Ngo, & Conway, 2003).

Finally, social work education should take the best advantage of initiatives to strengthen gerontological social work education with an emphasis on cultural competence. Social work education in both classroom and field-placement settings plays a significant role in enhancing social workers’ ability to practice culturally competent skills as well as in improving cultural awareness and cultural sensitivity. In reality, social work education and training have focused mainly on cultural awareness and cultural sensitivity, but not enough attention is given to facilitating culturally competent skills as a part of core curriculum.

Nevertheless, two recent initiatives can help us to move forward with our educational efforts to develop cultural competency-focused social work curriculum. One is an effort by the Council of Social Work Education/SAGE-SW project and the Practicum Partnership Program (PPP) (Damron-Rodriguez, in press). Funded by the John A. Hartford Foundation, the PPP is a graduate social work field education demonstration focused on aging and developed skill statements to create the Geriatric Social Work Competency Scale, which recognizes and includes cultural competence as an important component of gerontological social work competency. The second initiative, in California, addresses the needs for gerontological social work education with strong emphasis on cultural competence in social work. Building on the success of California Social Work Education Center (CalSWEC) in the education of child welfare, CalSWEC II Aging Initiative originated in 2004 to form a statewide coalition of major stakeholders (e.g., schools of social work, county social service agencies, and private nonprofit organizations) to develop core competency curriculum in gerontological social work with aging individuals and their families in California. Cultural competence is recognized as one of the important components in the development of core competency curriculum by the CalSWEC II Aging Initiative. Along with the Curriculum Development Institute program by the Council on Social Work Education (CSWE) National Center on Gerontological Social Work Education (Gero-Ed Center), it is expected that the these initiatives will provide a strong impetus for cultural competency in social work education as well as the infusion of gerontological contents into social work curricula.

Sidebar

Although the White-alone population aged 65 and older is expected to grow by 116.7%, other racial/ethnic groups are expected to increase by substantially greater margins: 262.1% for Blacks, 720.3% for Asians, 764.0% for Hispanics, and 553.4% for all other races.

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Author Affiliation

Jong Won Min, PhD, assistant professor, San Diego State University, School of Social Work. He also serves as a chair of Community and Cultural Responsiveness Workgroup for Acute and Long-Term Care Integration Initiative by Aging and Independence Services, County of San Diego, California, assisting community stakeholders with drafting minimum requirements for cultural responsiveness and cultural competencies of participating health plans for Medi-Cal recipients (i.e., persons with disabilities and older adults). He also is involved with CalSWEC II Aging Initiative as a lead for Curriculum Workgroup in developing curriculums for ensuring competencies for gerontological social work in the state of California. Correspondence regarding this article may be sent to jwmin@mail.sdsu.edu or 5500 Campanile Drive, San Diego, CA 92182.

Manuscript received: November 29, 2004

Revised: March 1, 2005

Accepted: March 29, 2005

Copyright Families in Society Jul-Sep 2005