Morley Final

ADA - Americans with Disabilities Act - 1990 The ADA defines disability as Enforcement of the ADA is handled: Classification of disability by ada 4 stage framework disabilities under ada

In 1990, the Americans with Disabilities Act (ADA) was passed. It was written to protect persons with disabilities from discrimination based on stigma. The ADA defines disability as any physical or mental impairment that substantially limits one or more major life activities such as caring for oneself, performing manual tasks, walking, seeing, hearing, speaking, breathing, learning, or working. Enforcement of the ADA is handled on a case-by-case basis. People are not entitled to protection under the ADA simply because they have been diagnosed with a disability. The disability must substantially limit their ability to perform major life activities. The ADA uses a four-stage framework to categorize the level of difficulty experienced by an individual, ranging from least to most severe (Cornell University, 2013; Jette, 2006; Masala & Petretto, 2008): 1. Pathology 2. Impairment 3. Functional limitation 4. Disability Multiple physical, mental, and developmental disabilities are covered by the ADA. Following is a partial list of these: (1) physical, sight, speech, or hearing impairments; (2) epilepsy; (3) muscular dystrophy; (4) multiple sclerosis; (5) cancer, heart diseases; (6) diabetes; (7) HIV or AIDS; (8) cognitive disabilities; (9) psychiatric disabilities; (10) specific learning disabilities; (11) developmental disabilities; and (12) recovered drug or alcohol addiction. The law places strict limits on employers when it comes to asking job applicants to answer medical questions, take a medical exam, or identify a disability. After a job is offered to an applicant, the law allows an employer to condition the job offer on the applicant answering certain medical questions or successfully passing a medical exam, but only if all new employees in the same type of job have to answer the questions or take the exam. Once a person is hired and has started work, an employer generally can only ask medical questions or require a medical exam if the employer needs medical documentation to support an employee's request for an accommodation or if the employer believes that an employee is not able to perform a job successfully or safely because of a medical condition. The law also requires that employers keep all medical records and information confidential and in separate medical files.

Medicare Part D George bush - goals

In 2007, as George W. Bush was winding down his two-term presidency, he put forward a comprehensive "Affordable Choices Initiative" to reform the private health insurance market. The goal was to harness market forces to make private health insurance cheaper for the people who needed it most. However, because the Democrats had just regained control of Congress, the plan was never passed. Today, Bush is best known for his 2003 Medicare prescription-drug benefit program, often referred to as Medicare Part D. Today, American citizens under age 67 are mostly insured by their or a family member's employer. The U.S. government provides most of the insurance for public-sector employees. Medical care is paid for through private insurance, as well as by government programs and patients paying their own bills out of pocket. Yet others are uninsured.

Affordable Care Act - 2010

In 2010, the Patient Protection and Affordable Care Act, known simply as the Affordable Care Act (ACA) sometimes ObamaCare, became law. The ACA is a comprehensive health care reform law that includes provisions to expand health insurance coverage, improve health outcomes, control health costs, and improve the U.S. health care delivery system. The ACA also expanded public programs such as Medicaid as a "public option" to make more disadvantaged Americans eligible for health care. The ACA bill was more than 2,000 pages long. Since 2010 insurance companies have not been allowed to deny coverage to children or adults for preexisting conditions such as asthma, HIV/AIDS, and so on. Also, children can now stay on their parent's policy up to age 26. Yearly limits on premiums are barred, which protects people with catastrophic illnesses. After the initial open enrollment period, every American citizen was required to have medical insurance by May 1, 2014, or face penalties from the Internal Revenue Service. By 2018, all insurance plans are supposed to offer preventive care with no copayments and no deductibles. The ACA was a controversial law to begin with, with opponents believing that it would lead the United States toward socialized medicine. Some private insurance providers and health professionals opposed the law as well, because they believed that some of the reforms would decrease their profits. And then public enrollment in the plans in late 2013 was chaotic because of deficiencies in the computer technology undergirding the enrollment system. Many of ACA's opponents were quick to predict that the act would fail to achieve its goals. By mid-2014, opinions variedas as to the extent to which the ACA is making a difference. For example, doctor, bioethicist, University of Pennsylvania professor, and former advisor to the Obama administration Ezekiel Emanuel (2014a) passionately defends and lauds the ACA in his book Reinventing American Health Care, reminding readers that insurance companies and not 293doctors participate in the exchange. In contrast, Fox News host Bill O'Reilly provocatively countered that "ObamaCare is moving toward the direction of walk-in clinics, which are staffed by physician assistants and nurse practitioners" ("Debate: Are Doctors Fleeing the ObamaCare Exchange?" 2014)

Cultural sensitivity

In and of itself, a mentally healthy population is paramount for enhancing unity, social integration, and inclusiveness in our society. Another consideration, however, is how the diversity of the American population plays out in the prevalence and treatment of serious mental illness. Exhibit 9.4 depicts the varying rates of mental illness among subgroups based on sex, age, and race or ethnicity. The paragraphs that follow elaborate on those differences. Age. Mental health problems can occur at any age; however, recognition of mental health problems and disabilities in children and adolescents is a relatively recent phenomenon that began in the late 19th century. That is not to say that mental illness does not exist in this age group: A large U.S. study found that "half of all mental disorders emerge by 14 and three quarters by 25 years of age. Translated this 389means that by the age of 21, 51% of young people will have experienced a diagnosable psychiatric disorder" (Rickwood, 2012, p. 18). Class. The relationship among health disparities, mental health disparities, and socioeconomic status is a complex and important one. The connection between the mind and the body is undeniable: Afflictions of the mind affect physiology, and afflictions of the body in turn affect psychology. The disproportionate rates of mental health problems in the lower social class show that mental health is associated with social inequality (Aneshensel, 2009). Additionally, the effects of negative social interactions and stigma are inversely associated with health and well-being (Chou & Chronister, 2011). Working-class people are more likely to be diagnosed with a mental illness than are those from nonmanual-labor backgrounds. Race and ethnicity. Although Exhibit 9.4 shows that African Americans have a lower rate of serious mental illness than the overall average for Americans, African Americans are more likely than their white counterparts to be diagnosed with schizophrenia (Bresnahan, Begg, Brown, Schaefer, & Sohler, 2007). On the other hand, nonHispanic blacks are 40% less likely than non-Hispanic whites to experience depression during their lifetime. Exhibit 9.4 also shows that American Indians and Alaska Natives have a prevalence of mental illness far above that experienced by any other group shown in the chart. Historical traumas in the form of forced relocations, cultural assimilation, multiple broken treaties, and other social and economic injustices have contributed to health and mental health disparities in this population. Mental health and disabilities also exert a disproportionately negative effect on racial and ethnic minority children. One reason for the disparity was cited in the final report of the President's New Freedom Commission on Mental Health (2003): "Specifically, the system has neglected to incorporate respect or understanding of the histories, traditions, beliefs, languages, and value systems of culturally diverse groups" (p. 49). Because some social work disability specialists and mental health service providers lack cultural competence, people of color frequently do not seek services in the formal system. Also, they are more likely to drop out of care, be misdiagnosed, or seek care only when their illness is at an advanced stage. "Fifteen percent of African Americans, 13 percent of Hispanics, and 11 percent of Asian Americans said there had been a time when they felt they would have received better care if they had been of a 390different race or ethnicity" (National Alliance on Mental Illness, 2012). Gender. In the United States, major depressive disorder is one of the most common mental disorders. Women are 70% more likely than men to experience depression during their lifetime. Comparatively, in the United Kingdom, depression is also more commonly identified in women. Sexual orientation. Lesbian, gay, and bisexual young people are at increased risk of mental health problems, particularly on measures of suicidal behavior and multiple disorders (Remafedi, French, Story, Reshnick, & Blum, 1998; Ryan & Futterman, 1998). Until recently, some gay men have also been pressured to "treat" their sexuality through mental health interventions. Most experts today agree that homosexuality cannot be "cured"—and in fact, should not even be considered a mental illness. The NASW (2000) position statement on this subject points out that research findings showing that conversion therapies work are confounded, and the organization does not stand by such therapies as a means of changing sexual orientation. Indeed, the NASW has stated that conversion therapies may actually harm mental health

deinstitutionalization statistics

-public inpatient beds decreased %60 between 1955-1977 and continued through the 80's and 90's -1975 500 federally funded community mental health centers + additional locally supported services then federal money for CMHC's slowed ennded in 1982 Block grants - state and local support varies from state to state -Community services often insufficient for needs

Eric Erikson's Eight Stages of Human Development

1. trust vs. mistrust, - hope (infancy) 2. autonomy vs. shame/doubt, will (early childhood 1 1/2 - 3) 3. initiative vs. guilt, -purpose (play age 3-5) 4. Industry vs. inferiority, 5. identity vs. role confusion -school age (5-12) 6. intimacy vs. isolation -young adult (18 - 40) 7. generativity vs. stagnation -adulthood (40-65) 8. Integrity vs. despair. maturity (65+)

12 step program

12-step approach: Traditional treatment model based on a moral and spiritual understanding of addictive behavior.

Developmental Disability

A developmental disability is a severe chronic disability that manifests before the age of 22 and is likely to continue indefinitely. It may occur because of a genetic predisposition or an issue before, during, or after the person is born (DeWeaver, 1983). Developmental disabilities are common and have increased, requiring more health and educational services.

managed care definitioon

A health care system with administrative control over primary health care services in a medical group practice. The goal is to reduce costs and eliminate redundant facilities and services

plea bargaining

A negotiation, often conducted by an attorney, with the prosecution for a reduced charge or sentence

neurocognitive impairment

A neurocognitive impairment is an encompassing term to describe any neurocognitive characteristic that blocks the cognition process. The term may describe deficits in specific cognitive abilities, global intellectual performance, or drug-induced cognitive/memory impairment, such as fromalcohol, glucocorticoids, or benzodiazepines. Neurocognitive impairments may be congenital or caused by environmental variables such as brain injuries, neurological disorders, or mental illness. Although a neurocognitive challenge is usually not visible, it is as legitimate an impairment to functioning as a physical disability is. Neurocognitive impairments include the following: Intellectual disability. Intellectual disability is a disorder characterized by significant limitations both in intellectual functioning and in the ability to adapt to circumstances, or adaptive behavior. The term intellectual disability is now used to describe the same population of individuals who were diagnosed previously with mental retardation. Every person who was eligible for a diagnosis of mental retardation is eligible for a diagnosis of intellectual disability. This disability varies in level, type, and duration, and degree of need for individualized services and supports. Intellectual disability ranges from mild (IQ 50-70) to moderate (IQ 35-49) to severe (IQ 20-34) to profound (IQ below 20), as measured by the Wechsler Intelligence Test. Learning differences. Learning disabilities or differences are neurological disorders that can make it difficult to acquire certain 335academic and social skills. They are not the result of poor intelligence or laziness. Well-known learning differences include dyslexia (hinders reading, writing, and spelling), dyscalculia (hinders math), dysgraphia (hinders writing, spelling, or putting thoughts to paper), dyspraxia (affects motor skill development), poor executive functioning (governs one's ability to plan, organize, and manage details), and attentiondeficit hyperactivity disorder. Learning differences do not disappear with time. Traumatic brain injury. Traumatic brain injury usually results from a violent blow to the head or body, or when an object, such as a bullet, penetrates the skull. Such an injury can have wide-ranging physical and psychological effects due to damage to the brain. Some symptoms may appear immediately after the traumatic event, while others may appear days or weeks later

codependency

A substance use disorder may also progress because other people in the user's environment are enabling the substance abuse. The term for the relationship between the user and these other people is codependency. They rely on each other to meet reciprocal needs, especially unhealthy emotional needs. For example, a young woman puts up with controlling behavior and insults from her boyfriend because she wants to be with a man. Or a dad steps in to protect his son from the consequences of poor behavior instead of teaching his son the proper way to behave. The person with a substance abuse problem needs treatment to break the grip of the substance or behavior. In addition, the people who have covered up or enabled the substance abuse (often referred to simply as codependents) need counseling to understand how their behavior is hurting everyone. Although they may accept that their "caretaking" behavior is making it more difficult for the person with the substance use problem to recover, they often have more difficulty understanding how codependency is hurting them in return. An example of this caretaking behavior is when a wife covers up for her alcoholic husband so he does not lose his job. 410Researchers and clinicians have found that many codependents focus too much outside of themselves, do not express their feelings, and take too much personal meaning from their relationship with the person who has an addiction (Beattie, 2009, 2011; Knudson & Terrell, 2012, p. 245). Codependency appears to originate primarily in the family of origin, particularly in families where the parents are perceived to have a turbulent relationship; interestingly, however, codependent behavior does not seem to be related to substance abuse in the family of origin (Knudson & Terrell, 2012). In any event, codependents may appear as people pleasers, denying themselves and their own needs because they are or have been so busy taking care of others.

5 factor model

A trait approach used to categorize people on the basis of personality. The five traits are neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness

Acute inflammation

Acute inflammation is the inflammation that occurs in the immediate or short-term aftermath of an injury or disease. The five hallmarks of acute inflammation can be remembered by the acronym PRISH, which refers to the signs of inflammation: pain, redness, immobility, swelling, and heat. Pain is when people have inflammation and it hurts; they feel stiff, uncomfortable, or distressed and in agony depending on its severity. Pain can be constant or steady, such as an ache, or it can be a throbbing type with pulsating pain or a stabbing, pinching pain. Pain is an individual experience, and the only person who can describe it properly is the one who is feeling it. Pain can be acute or chronic

Alcohol

Alcohol is the most commonly used psychoactive, or brain-affecting, substance. About 1 in 4 people who drink heavily may have alcohol abuse problems (Larson, Wooten, Adams, & Merrick, 2012; Roman, 2014). Alcoholism is a chronic and often progressive disease that includes problems controlling your drinking, physical dependence on alcohol, or having withdrawal symptoms when you stop drinking. Although it is not always associated with alcoholism, binge drinking is a common problem among young people. It means drinking so much within about 2 hours that blood alcohol concentration (BAC) levels reach 0.08%. For women this usually occurs after four drinks and for men after five. Drinking too much, whether as an alcoholic or a frequent binge drinker, can affect your brain, heart, liver, pancreas, cancer potential, and immune system. Impaired driving related to alcohol, or drunk driving, is a significant public health problem. Generally, in the United States, a BAC of 0.08% is 411considered the legal limit for being charged with the criminal offense of driving while intoxicated (DWI). The U.S. Department of Transportation found that in 2012, 10,322 people were killed in alcohol-impaired-driving crashes. Further, these fatalities accounted for 31% of the total motor vehicle traffic fatalities in the United States (Centers for Disease Control and Prevention, 2011a). According to the Centers for Disease Control and Prevention, young drivers (ages 16-20) are 17 times more likely to die in a crash when they have a BAC of 0.08% than when they have not been drinking. Also, 1 in 5 teen drivers involved in fatal crashes in 2010 had some alcohol in their system. Most of these drivers (81%) had BACs higher than the legal limit

AA/NA

Alcoholics and Narcotics Anonymous One way of quitting addiction is attending Narcotics Anonymous (NA) or Alcoholics Anonymous (AA), which are both 12-step programs. No judging occurs in these programs. NA uses AA principles that focus on "working the 12 steps." Twelve-step programs involve admitting to having a serious problem, recognizing there is an outside (or higher) power that could help, consciously relying on that power, admitting and listing character defects, seeking deliverance from shortcomings, apologizing to people you have harmed, and helping others with the same problem. Al-Anon Family Groups are related programs. The families of users share their experiences, strengths, and hopes in an effort to solve common problems. Like AA and NA, Al-Anon is not allied with any sect, denomination, political entity, organization, or institution. There are no membership dues, and the fellowship is self-supporting through members' voluntary contributions.

prosecutor

An attorney representing a government entity (e.g., city, county, state, federal), arguing that the accused is guilty

Chronic inflammation Examples of diseases

Chronic inflammation lasts for several months or years and can occur as a result of an autoimmune response, a chronic irritant, or failure to eliminate the cause of inflammation. Examples of diseases and conditions that produce chronic inflammation are asthma, chronic peptic ulcer, tuberculosis, rheumatoid arthritis, chronic periodontitis (infected gums), ulcerative colitis and Crohn's disease, chronic sinusitis, and chronic hepatitis, to name a few. The risk of chronic inflammation is much greater if the person is obese.

probation

Constitutes a sentence given to an offender by a judge, typically in lieu of prison, carrying specific requirements and conditions (e.g., regular reporting, counseling, drug testing, substance treatment) monitored by a probation officer

PTSD

Defining PTSD is difficult and much debated. Research on proper and specific treatments for PTSD has also proven difficult, especially with regard to veterans of combat and peacekeeping missions. Combat PTSD is harder to treat than the civilian type because it is more chronic and complex (Rubin et al., 2013, p. xxiv). The term PTSD was coined during the Vietnam War. Many veterans of that war had high scores on measures of depression, hostility, and psychoticism, as well as survivor's guilt, unreality, and suicidal tendencies. Also, Vietnam vets had a greater lifetime frequency of panic disorder and an earlier age of onset for alcoholism. Today the signs and symptoms of PTSD are described more in terms of an anxiety disorder (American Psychological Association, 2013; cited in Rubin, 2012, p. 87). It is unique among psychiatric diagnoses because of the great importance placed on the stressor that caused it. Events such as rape, torture, genocide, and severe war zone stress will be experienced as traumatic events by almost everyone; however, there are some unique features of PTSD in warrior populations. For example, combat veterans may relive experiences through flashbacks, nightmares, and trigger responses. Vets may also try to avoid crowds, driving, or war movies if such remind them of a combat situation. As well, veterans with PTSD may feel keyed up (hyperaroused) and experience negative changes in feelings and beliefs (e.g., not trusting people, thinking the world is a dangerous place)

deinstitutionalization

Deinstitutionalization In the 20th century, as the horrors of some institutions for the disabled became better known, some reformers began advocating deinstitutionalization, or the removal of people with physical and mental challenges from institutions and better integration into the community. From 1965 to 1980, as the idea of deinstitutionalization took hold, public asylums lost about 60% of their inmates (Nielsen, 2012). With the disability rights movement of the late 1960s, people with physical and mental challenges, along with their friends, family members, and professionals, endeavored to change the view that a person with a chronic illness or disability will always be unable to cope independently with life. The disability rights movement argued that just like other minorities, people with disabilities are disadvantaged as much or more by discrimination as by their physical limitations. Many asylums and other institutions were closed, and their residents were sent home to enjoy life on their own. Independent-living centers began to appear in the late 1960s and espoused the principles of self-determination and deinstitutionalization. They are community agencies, usually staffed by people with disabilities, who use peer counseling and advocacy to help others live on their own. A distinct culture and philosophy resulted from this independent-living movement and now exists around independent-living centers. However, in the 1970s and 1980s, professional caregivers, advocates, and decision makers were already beginning to realize that deinstitutionalization was leaving some disabled persons without enough support. Only the privileged or lucky few were able to be housed in independent-living centers, community-based mental health centers, or group homes. The rest were being left to fend for themselves on the streets or were incarcerated. Today, people who have intellectual disability and mental illness and who lack the resources for professional care most often end up in jail or prison. However, in 2009 the Department of Health and Human Services created the Community Living Initiative. The initiative developed and implemented innovative strategies that increase opportunities for Americans with disabilities and older adults to enjoy meaningful community living. The Affordable Care Act, signed into law in 2010, expands the scope of the initiative and helps U.S. states promote and support community living for people with disabilities.

DSM V Most mental health care providers would agree that ideal mental health includes:

Diagnostic and Statistical Manual of Mental Disorders (DSM) Also, social norms change over time and thereby complicate definitional matters. For example, homosexuality, until 1990, was considered a psychological disorder by the World Health Organization's International Classification of Diseases, and the American Psychiatric Association did not remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM) until 1973. Today, however, homosexuality is considered acceptable and not a mental disorder. Most mental health care providers would agree that ideal mental health includes the following (McLeod, 2014): Accurate perception of reality Autonomy and independence Capability for growth and development Environmental mastery—ability to meet the varying demands of dayto-day situations Positive friendships and relationships Positive view of the self The reality is that ideal mental health is not always obtainable, and the human brain affects human thoughts and actions. But because not all symptoms and problems in living are caused by mental disorders, mislabeling can be very harmful to people who are deemed "abnormal." Similarly, when a person has been evaluated as having a mental illness or mental disorder, it is important to be sensitive about the language used to describe her or him. Person-first language, discussed in detail in Chapter 8 in relation to physical and mental challenges (disabilities), is meant to play up the individual's worth and downplay the disability. For example, instead of saying, "He's bipolar," it would be more appropriate to refer to "a man with bipolar disorder." __________ In America, mental disorders are classified and diagnosed based on the DSM. This manual, published by the American Psychiatric Association, serves as a universal authority for psychiatric diagnosis. Oftentimes, 370treatment recommendations and payment by insurance companies to health care providers are determined by DSM diagnostic codes. Mental health social workers routinely use the DSM to "label patients"—particularly at inpatient hospitals, mental health clinics, and outpatient health centers—so the client can be reimbursed through insurance. The DSM is currently in its fifth edition (DSM-5; American Psychiatric Association, 2013), and every update has brought noteworthy changes. For example, the current edition dropped Asperger's syndrome as a mental disorder and changed the criteria for posttraumatic stress disorder (discussed in more detail below). In its opening section, the DSM acknowledges that definitions of mental disorders are imprecise. The definitions actually describe patterns of behavior and severity levels that are evident. Forthrightly, the DSM states that people are not diagnosed; their disorders are. Although DSM classification occurs regularly in real-world social work practice, social work educators continue to debate the utility of teaching such classification schemas. The DSM has both proponents and critics. Critics find it necessary to remind mental health counselors that their relationship with a client should come first and that any diagnosis should be a team effort. In addition, a member of DSM task forces who is a clinician, educator, researcher, and leading authority on psychiatric diagnosis (Frances, 2013) has noted some specific problems with the DSM-5: The DSM-5 suffers from the unfortunate combination of unrealistically lofty ambitions and sloppy methodology.... Unless diagnoses are used with restraint millions of essentially normal people will be mislabeled and subjected to potentially harmful treatment and unnecessary stigma. The DSM-5 has lowered the requirements for diagnosing existing disorders. For example, 2 weeks of normal grief have been turned into Major Depressive Disorder. The criteria for adult ADHD have been loosened, making it easily confused with normal distractibility and facilitating the illegal misuses of prescription stimulants for performance enhancement or recreational purposes. The DSM-5 has collapsed early Substance Abuse and end-stage Substance Dependence (addiction) into one category, confusing their very different courses and treatment needs and creating unnecessary stigma. (p. 5)

Mental health/behavioral health

Failure to cope adequately with the demands of everyday life may be a sign of a mental health problem or disorder. When a person is suffering, maladaptive (a danger to self), unpredictable to the point of losing control and being irrational, causing an observer discomfort, and violating a moral or social standard, that person is failing to function adequately. Mental disorders are common in the United States and globally. Although mental disorders are widespread, the main burden of illness is concentrated in about 6% of the population. About 1 in 17 people suffer from a severe mental illness. Mental illness is caused by multiple factors, including accidents, poor choices, and genetic predisposition. ______________________ Mental health connotes a relative state of emotional well-being where one is free from incapacitating conflicts and is consistently able to make rational decisions and cope with environmental stresses and internal pressures. By contrast, mental illness is a disease that causes mild to severe disturbances in thinking, perception, and behavior. Mental illnesses are symptoms of mental disorders, which vary in duration and severity, and can affect persons of any age, class, race, and ethnicity. If these disturbances significantly impair a person's ability to cope with life's ordinary demands and routines, then they will likely require proper treatment from a mental health professional. The terms behavioral health and mental health are often used interchangeably, and the term perceptual health has also been introduced because helping professionals' perceptions may often lead to harmful actions toward patients. Behavioral health includes prevention and wellbeing promotion and is a hopeful concept for people who feel that mental illness is a permanent part of their lives. Behavioral health is also a kinder term than mental health and may help reduce the stigma. Behavioral health can also place the onus on the individual to change rather than considering external environmental factors such as poverty, discrimination, or abuse, thus obliterating the underlying causes of suicidal behaviors and conveying a concept more reminiscent of an insurance company than of someone struggling with mental health issues

Veterans admistration VA

Following World War II, social workers provided increasing behavioral health care to military personnel, veterans, and military families across multiple branches and contexts. Today, licensed social workers may choose to work as full-time uniformed military officers or as civilians for the Department of Veterans Affairs (VA) and veterans' centers. Social workers can also work part- or full-time as civilians who are contracted by the armed forces or the VA. Social workers can also work with veterans and military families as private practitioners through the military's health insurance plan. The United States Department of Veterans Affairs (VA) is a federal Cabinet-level agency that provides near-comprehensive healthcare services to eligible military veterans at VA medical centers and outpatient clinics located throughout the country; several non-healthcare benefits including disability compensation, vocational rehabilitation, education assistance, home loans, and life insurance; and provides burial and memorial benefits to eligible veterans and family members at 135 national cemeteries.

Co-morbid conditions/ co-occurring disorders Dual diagnosis

For clients who present with co-occurring disorders—for instance, depression and substance abuse or paranoia and aggressive tendencies— social work treatment is shifting to a holistic approach that involves combining rather than separating health care, substance abuse treatment, and mental health care. Increasingly, social workers in mental health will be required to have the skills and knowledge to provide treatment for co-occurring mental health disorders simultaneously.

Frictional Unemployment

Frictional unemployment: Part of the normal labor cycle and considered unavoidable. Frictional unemployment is triggered when people leave their place of employment or are fired from their job. Unemployment occurs not because jobs are unavailable or the unemployed lack skills; rather, frictional employment reflects the amount of time it takes an employer to find another worker. Two critical factors contribute to frictional employment: Employers are unaware of available workers and their specific skill sets, and available workers are unaware of the open jobs. In essence, frictional employment is the result of an inadequate exchange of information, and so the solution is to make sure information about jobs and workers is freely available

Physical disabilities

Functional disabilities limit a person's ability to perform physical activities, and they often can be ameliorated with assistive devices or technology

Interdisciplinary team

Health Care and Social Work Health social workers have long provided people with biopsychosocialspiritual support needed to cope with acute illness, chronic illness, or terminal illness. Services provided by professional health social workers include advocating for patients and family caregivers; assessing needs; providing care and case management; educating and counseling; intervening to promote health, prevent disease, and address disparities and barriers to health care; and providing information and referrals. Because health care is "big business," social workers can also take business and accounting classes to help prepare them to manage community-based agencies and social service organizations. Health care social workers require interdisciplinary knowledge about acute and chronic illnesses, accidents and injuries, genetics and birth abnormalities, neuroscience, and death. Hospice workers in particular require a comfort level with end-of-life and palliative-care issues.

Medicare - 1965 - Title XVIII Part A Part B Part D Part C

Health insurance and Medicare. Older people had to pay for their own health care until the Medicare legislation was enacted as part of the Social Security Act of 1965. For a very low monthly fee, Medicare Part A covers hospitalization and some follow-up care. Medicare Part B pays for outpatient hospital care and some doctor's services (older adults must pay an additional premium to get Part B coverage). Medicare C only partly covers around 100 days for nursing home care and blood draws. The relatively new Medicare Part D provides for prescription drug coverage. Area Agencies on Aging. In 1965 the very important federal-level Older Americans Act was enacted. Its mission was to keep older adults living independently for as long as possible by providing information on services that are available to them. To do so, it authorized state units and local Area Agencies on Aging. Amendments to the Older Americans Act, approved in 1981, allowed for information and referral services for non-English-speaking older adults; provided legal services and transportation; and offered in-home assistance in the form of health aides, homemakers, and visiting and telephone reassurance activities.

Deinstitutionalization

Institutionalization and Deinstitutionalization The institutionalization of people subject to bizarre outbursts dates back to the 13th century. European colonists brought their views of how best to care for people who were mentally ill to North America. They thought institutionalization of people who needed a safe, controlled environment was a good idea. However, in colonial America there was no institutionalization—if you were experiencing a mental disorder, you were left to your own devices or jailed as a criminal. It wasn't until 1773 that "hospitals" specializing in mental health opened in the United States. Today, institutionalization is a core part of what many think about when talking about disability in the United States. However, in the United States, institutionalization has more often had the connotation of criminalization than of treatment. People in power often viewed people with mental health disabilities as a threat to social and political structures. Political thinkers supported a movement toward long-term hospitalization so the "insane" could not access the rights of citizenship and make societal decisions. Institutionalization can serve larger ideological purposes as well. The warehousing of those considered deviant, coupled with the threat of sterilization, literally controlled the reproduction of troublesome norms of behavior (Nielsen, 2012, p. 119). Consider that suicide was not struck from all states' lists of felonies until the 1990s. In the 1960s, U.S. policymakers and citizens began to embrace deinstitutionalization. It was in large part the philosophy behind the civil rights movement that put an end to long-term hospitalization for developmentally disabled people, mentally ill people, criminal offenders, and children and older adults (Segal, 1995). The rationale that helped make deinstitutionalization a reality, however, was preventing unnecessary admissions to institutions and thereby containing costs. As the United States closed down its large residential institutions, mental health care shifted to outpatient treatment in clinics, short-term hospitalization, and supervised group homes in the community. After Medicaid was passed in 1965, community mental health centers tried to accommodate the patients who were being released from state medical hospitals. This strategy allowed Medicaid to extend coverage for psychiatric hospital care to poor people and created incentives for states to place in nursing homes older adults who manifested behavioral problems. As a result, during the 1960s the nursing home population doubled (Grob, 1991). Some who were released did not completely understand what was transpiring. Staffers in some of the facilities did not fully understand the mental health needs of their new charges. Although the philosophy that undergirded deinstitutionalization was "laudable," it has been the "largest failed social experiment in twentieth century America" (Torrey, 1995, p. 1612, cited in Peternelj-Taylor, 2008, p. 185). In some jurisdictions, deinstitutionalization has dramatically increased homelessness and been blamed for the criminalization of the mentally ill.

Integrative medicine

Integrative medicine, or integrative health as it is called in the United Kingdom, is healing-oriented medicine that considers the whole person (body, mind, and spirit), including all aspects of his or her lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative or complementary. These are some of the main principles of integrative medicine (Lemley, n.d.): A partnership between patient and practitioner in the healing process Appropriate use of conventional and alternative methods to facilitate the body's innate healing response Consideration of all factors that affect health, wellness, and disease Use of natural, effective, less-invasive interventions whenever possible Training to make health care practitioners models of health and healing, committed to the process of self-exploration and selfdevelopment

Military Culture - 4 Pillars

It requires strict discipline throughout the hierarchy. It relies on soldiers' values of loyalty and self-sacrifice to keep order in battle. It uses ceremonies and rituals to create common identities among its members. It emphasizes group cohesion and esprit de corps to keep soldiers

suicide

Late-life suicide is concerning and requires more attention from health care providers, researchers, policymakers, and society at large (Joiner, 2005; Manetta & Cox, 2013). Of all age/gender/race groups, white men over the age of 85 are at the greatest risk of completing suicide. Comparatively, the rate of suicide for women tends to decline after age 60 (after peaking in middle adulthood, ages 45-49; American Association of Suicidology, 2012). Although older adults attempt suicide less often than people of other age groups, they have a higher completion rate. Firearms are the most common means used for completing suicide among older adults, with men using firearms far more often than women (Callanan & Davis, 2012; Lester, Haines, & Williams, 2012). A leading cause of suicide among older adults is untreated depression. Gerontological social workers need to ask relevant assessment questions to determine their clients' suicide risks. Common risk factors include the recent death of a loved one; physical illness, uncontrollable pain, or the fear of a prolonged illness; perceived poor health; major changes in social roles (e.g., retirement); and social isolation and loneliness.

HMO, PPO Electronic Medical Records Idea of health maintenance strategy? Point of services plans Which is the lease expensive and why?

Health maintenance organization (HMO). An HMO is a coordinated delivery system that combines both the financing and delivery of health care for enrollees. In each plan a member is assigned a "gatekeeper" primary care physician who is responsible for the overall care of that member. In an HMO plan, patients pay less in insurance premiums and a nominal copayment at the time of service. The idea of a "health maintenance strategy" was first proposed by Dr. Paul Elwood in the 1960s, and the concept was promoted by the Nixon administration as a fix to rising health care costs. HMOs are licensed at the state level. Preferred provider organization (PPO). A PPO generally does not require copays and instead requires that patients cover a "deductible" (a preset sum for any service) before any benefits are provided. After the deductible is met, the insurance company and the patient split the costs of benefits. Because the patient is picking up a large portion of the "first dollars" of coverage, PPOs are the least expensive type of coverage. A point-of-services plan combines features of PPOs and HMOs. What they all have in common is that patients must be preauthorized by an insurance carrier to qualify for specific services; patients with managed-care plans cannot simply make an appointment with any doctor. Exhibit 7.3 provides a breakdown of distinctions among managed-care organizations. The growth of managed care in the United States was triggered by the enactment of the Health Maintenance Organization Act of 1973. Today managed care is almost ubiquitous in the United States but has been controversial because of its mixed results in trying to control medical costs. Proponents of managed care believe that it has increased efficiency, improved overall standards, and led to a better understanding of the relationship between costs and quality. It has promoted the practice of evidence-based medicine, which is now used to determine when lower-cost treatment may be more effective. Critics of managed care argue that "forprofit" managed care has been an unsuccessful health policy because it has contributed to higher health care costs, increased the number of uninsured citizens, driven away health care providers, and applied downward pressure on quality.

Health disparities/health care inequalities

Health science writers continuously reveal how the dynamics of health care, poverty, race/ethnicity, age, and gender intersect with disease. For example, not all Americans have access to the wondrous surgical procedures available to some, such as kidney transplants, technologically advanced rehabilitation processes, and psychopharmacology. Socioeconomic status has been and remains persistently related to stressful and harmful living conditions, disease, and lack of access to adequate health care. For example, when waste plants are built near impoverished neighborhoods, health problems ensue in those neighborhoods. In addition, impoverished people often have less access to fruits and vegetables than to candy, cookies, snacks, and cheap foods containing large amounts of corn syrup, which leads to alarming rates of obesity and diabetes. Unfortunately, impoverished and other oppressed people often do not have access to the health care that could help them treat their conditions. The term health disparities (also called health care inequality) refers to gaps between population groups in the availability and quality of health care, disease rates and severity, and overall health (U.S. Department of Health and Human Services, 2014). In the United States, health disparities are well documented in African Americans, Native Americans, Asian Americans, Pacific Islanders, and Latinos. Underprivileged groups distinguished by socioeconomic status or sexual orientation also experience health disparities. One major contributor to health disparities has been a difference in access to health insurance. In the United States, health insurance is typically provided by employers but usually only to full-time workers who are not earning minimum wage. A 2013 report in The New York Times, using Census data, revealed that about 44 million Americans have no health insurance (Bloch, Ericson, & Giratikanon, 2013). People who are medically uninsured tend to postpone necessary care and forgo preventive care, such as childhood immunizations and routine checkups. Uninsured people usually have no regular physician and limited access to prescription medications. Therefore, they are more likely to be hospitalized for health problems that could have been avoided. More than one third of uninsured adults state that they have problems paying their bills, which explains why many do not seek care until the last minute. When uninsured people cannot pay medical bills, the burden falls on those who do have insurance. Billions of dollars of "uncompensated care" drive up health insurance premiums for everyone.

fear of loss of function and activity

Hospice social workers often note that the greatest fear people express related to death is that they will lose control over the circumstances of their dying and be forced to endure pain, suffering, and indignities they did not choose. Many people fear this more than they fear death itself

home health care Hospice, End-of-Life, and Palliative Care

Hospice, End-of-Life, and Palliative Care As the end of life approaches, health care can take a far different approach. Instead of aggressively treating a disease or injury—with surgeries, medications, and life-support devices such as breathing apparatus and feeding tubes—the patient is allowed to die peacefully and with dignity. Family and friends also get the support they need. Hospice and palliative care focus on caring, not curing. Hospice care becomes available when a patient faces a terminal illness or painful injury and is believed to have 6 months or less to live. Hospice is not a place, per se; care often occurs in a person's home. Occasionally, hospice social workers visit residents in nursing homes and hospitals to conduct intakes. Hospice involves a team-oriented approach to expert health care, pain management, and emotional and spiritual support that is tailored to what individuals need and want. Support is also provided by and for a patient's loved ones. Hospice is considered the model for quality, compassionate care.

Health Insurance Portability and Accountability -blue cross/blue shield -history When were hospitals first conceptualized? First surgery using anesthesia?

Long ago, a lone general practitioner would make house calls, offer folk or home remedies, and take livestock as payment. Today, the United States boasts a health care complex comprising general practitioners and specialists, clinics, hospitals, pharmaceutical companies, and health insurance providers. Hospitals were first conceptualized during the Civil War, and new hygienic techniques were introduced. Much later, in 1846, the first surgery using anesthesia was performed at Massachusetts General Hospital, and diagnostic X-rays were first used in 1895. After the Great Depression in the 1930s, —or the health care provider—second party—involved in financing personal health services) insurance plans, such as those provided by the federation of separate health insurance organizations and companies referred to as the Blue Cross and Blue Shield Association, were devised to help pay doctors and not-for-profit hospitals for their ever-moresophisticated services. Blue Cross and Blue Shield began as separate organizations in 1929 and 1939, respectively. In 1982, they merged to form the current association. For-profit hospitals arrived during the 1940s. These businesses required their customers (i.e., patients) to pay for services and third-party payer (an organization other than the patient—first party eventually crushed the public health services sector. Once employers began providing insurance, people's access to health care became more complicated. Insurance needed to be portable so that when people went from one job to another, their health care would still be covered. Over time, health insurance has become a requirement to access good health care services (Green & Rowell, 2014)

Medicaid Eligibility Funding

Medicaid, a health care program created in 1965, pays for medical and hospital services for people who cannot afford them. Eligibility is based on income level and inability to pay for health care insurance. Funding comes from federal, state, and sometimes county governments. In most areas, Medicaid is administered via local public assistance offices

Medicaid

Medicaid, the State Children's Health Insurance Program, and Medicare are the federal resources that pay for health care. The U.S. government also provides medical programs for families of members of the armed forces and supports Veterans Affairs hospitals. A huge 65% of health care provision and spending derives from Medicare, Medicaid, TRICARE, the Children's Health Insurance Program, and the Veterans Health Administration.

Medicare includes funding from medicare comes from:

Medicare, the U.S. national social insurance health care program for everyone older than 65, includes coverage for hospital stays (extended hospital care), home health services, hospice care, and voluntary medical insurance (e.g., doctor's fees, outpatient services). Medicare also covers people with end-stage renal disease. Medicare Part D, a relatively recent benefit, pays for part of prescription drug costs. Funding for Medicare comes from Social Security contributions, monthly premiums from participants, and general federal revenues (Barker, 2014, p. 264)

Mental Health Parity Act

Mental Health Parity Act, which took effect in 1998, were positive. Under this act, employers who provided mental health benefits to their employees could not place stricter caps on those benefits than they placed on medical and surgical benefits. The National Association of Social Workers celebrated passage of the act and called it a "first step" toward mental health parity. However, it eventually became apparent that this act would not have the desired effect. It did not require employers to provide mental health benefits, and it did not keep insurance plans from imposing other restrictions on mental health benefits

mental health and drug courts

Mental Health and Criminal Justice One prevailing belief in the United States is that the criminal justice system is a haven for people with serious mental illness. As Chapter 9 explained, in the 1960s, mental health services were deinstitutionalized, and jails and prisons increasingly became the default residence for people with serious mental illness who caused too many problems in the community. Simply stated, in lieu of receiving the residential mental health services they needed, members of this population were arrested for manifesting symptoms of their mental illnesses. Social workers have been long-standing advocates for programs to address the needs of people experiencing mental health challenges. People with mental illness who end up in jail for inappropriate and unlawful behavior particularly need assistance. The increasing number of mental health and drug courts is a sign of progress, but convincing public officials and decision makers to invest in mental health programs and decriminalizing mental health is a challenge.

Health Care Settings

Multiple types of health care organizations employ social workers. For example, health social workers work in acute care, hospitals, home health, long-term care, hospice and palliative care, clinics, and rehabilitation. All these health care settings are practice areas in which assessment, care, and treatment address the physical, mental, emotional, and social well-being of the person. Health settings address prevention, detection, and treatment of physical and mental disorders with the goal of enhancing the person's biopsychosocial and spiritual well-being. The health care setting includes personnel who provide the necessary services (e.g., physicians, nurses, social workers, hospitalists, care managers), appropriate service delivery facilities (e.g., hospitals, hospices, assisted-living facilities, nursing homes, medical centers, urgent care centers, and outpatient clinics), and educational and environmental facilities that work to help prevent disease. In the United States, health care is provided by multiple distinct organizations mostly owned and operated by private businesses. For example, about 62% of U.S. hospitals are nonprofit, 20% are government owned, and 18% are for-profit

Adult day care Costs

NJ average -$85 a day 5 days a week = about $1700 a month Some services eligible for coverage

National Alliance on Mental Illness NAMI

National Alliance on Mental Illness (NAMI) are involved in advocacy efforts that dismiss deficits and stigma and strongly uphold a focus on assets. NAMI was founded in 1979 by people with mental illness who call themselves "consumers," along with their family members and concerned professionals. NAMI supports research, education, social policy, and political activities that help improve access to community-based services. Today, NAMI has affiliate offices in all 50 states. Mental health teams now collaborate to link clients with community-based day programs that teach skills to people diagnosed with mental health problems and urge physicians to prescribe a broad assortment of psychotropic medications, such as antidepressants and antimanic medications, that help people with mental illness function well in society. The environment has changed significantly. In the early 1970s, when George McGovern was running for president, it came out that his vice presidential running mate, Thomas Eagleton, had suffered depression, been hospitalized for it, and received electroconvulsive therapy. The revelation was so shameful that Eagleton was dropped from the ticket without discussion, and McGovern lost the election in a landslide. Today, however, thanks to activists such as NAMI members, people with mental illness hold esteemed positions in the workplace and wider society. A few esteemed individuals who have overcome mental illness are actress Catherine Zeta Jones, who lives with bipolar disorder; Olympic swimmer Michael Phelps, who excels despite his ADHD; mathematician John Nash, who won a Nobel Prize despite living with schizophrenia; and guitarist Keith Urban, who successfully overcame alcoholism and continues to write songs and serves as a judge on the American Idol television show. Exhibit 9.1 provides an overview of the important movements related to mental health care in the United States.

Electronic Medical Records

National policy changes have prompted the adoption of electronic medical records (EMRs), which allow physicians to maintain electronic files of lab results, visit notes, diagnostic test results, insurance information, demographics, health histories, and other medication information within their offices. The companion to EMRs are EHRs (electronic health records), which facilitate the electronic exchange of EMRs between providers, thereby allowing the medical record to "follow" patients when they see different providers

Types of disorders in the DSM

Neurocognitive disorders: The new descriptor for disorders that involve delirium or dementia. "Dementias" include diseases such as Alzheimer's, which leads to loss of mental functions, including memory loss and a decline in intellectual and physical skills. Personality disorders: The cause of vicious cycles of negative experiences where people cannot adapt to change and become distressed. Personality is an enduring pattern of behaving, feeling, interacting, and thinking that forms who we are. Ten personality disorders are classified in the DSM-5: borderline, antisocial, narcissistic, histrionic, obsessive-compulsive, avoidant, dependent, paranoid, schizoid, and schizotypal personality disorder. Anxiety disorders: Formerly lumped together with depressive disorder and bipolar disorder under the classification of "mood disorders," anxiety disorders, which include phobias and panic disorders, are common. People who suffer from phobias experience extreme fear or dread of particular objects or situations. Panic disorders involve sudden intense feelings of terror for no apparent reason and symptoms similar to a heart attack. Depressive disorders: Formerly categorized as mood disorders, along with anxiety and bipolar disorders, depressive disorders are also common. People lose their ability to concentrate, think clearly, or make simple decisions when they experience depression. Bipolar disorder: This was formerly listed among mood disorders such as anxiety and depressive disorders. Diagnoses of bipolar disorder abound. Between 1984 and 2014, diagnoses of childhood bipolar disorder have increased fortyfold, thereby becoming an epidemic and a "fad diagnosis." A bipolar diagnosis carries the connotation that it will last for a lifetime and require continuous treatment with medication (Frances, 2013, p. 53). Schizophrenia spectrum and other psychotic disorders: A serious disorder that affects how a person acts, feels, and thinks, schizophrenia is believed to be caused by chemical imbalances in the brain that produce multiple symptoms, including delusions, hallucinations, impaired reasoning, incoherent speech, and withdrawal. Eating disorders: This label includes anorexia nervosa and bulimia, which are serious, potentially life-threatening illnesses. People with 372these disorders have a preoccupation with food and an irrational fear of being fat. Anorexia is self-starvation, while bulimia involves cycles of bingeing (consuming huge amounts of food) and purging (abusing laxatives or self-inducing vomiting). Behavior may also include excessive exercise. Neurodevelopmental disorders: This broad category includes three noteworthy disorders, usually first diagnosed in childhood and adolescence—attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder, and oppositional defiant disorder. Depending on its presentation, autism may be deemed a disability or simply a mental health issue. The fundamental truth about developmental disorders such as autism and dyslexia is that they are wrongly classified as childhood disorders. They are lifelong conditions that can be exacerbated by stress and unfamiliar situations, and can lead to mental collapse (Frith, 2014, p. 671). While autism has always been with us, it has been recognized only since the mid-20th century. Despite this slow start, the spectrum of autism is now incredibly broad. Posttraumatic stress disorder (PTSD): Applies when someone has suffered through an unusually dreadful trauma (e.g., combat, rape, torture, battery, or qualifying catastrophes such as fires, accidents, floods, earthquakes, hurricanes). However, the diagnostic criteria are more descriptive of the symptom-based outcome than of the precipitating event itself. One person may suffer PTSD due to a precipitating event that others might not consider "unusually dreadful." There are numerous variables that can influence whether and to what extent an event or experience is traumatic. Recovery from an accident, traumatic brain injury, or physical abnormality requires specialized treatment and an interdisciplinary team approach.

Medicare - 1965 - Title XVIII

Older people had to pay for their own health care until the Medicare legislation was enacted as part of the Social Security Act of 1965. For a very low monthly fee, Medicare Part A covers hospitalization and some follow-up care. Medicare Part B pays for outpatient hospital care and some doctor's services (older 484adults must pay an additional premium to get Part B coverage). Medicare C only partly covers around 100 days for nursing home care and blood draws. The relatively new Medicare Part D provides for prescription drug coverage.

palliative care

Palliative care focuses on relieving and preventing the suffering of patients, whether they are expected to die soon or not. It is provided by physicians, nurses, and social workers who specialize in the relief of pain, symptoms, and stress that accompany serious illness. However, like hospice, palliative care embraces the idea that at the end of life, comfort is more important than continued aggressive treatment. Social workers help people face terminal illness, find peace, and appreciate life (Faherty, 2008)

Respect for indivodual dignity and self worth

People need and deserve respect and acceptance, regardless of their mental health. People with a mental disorder still require understanding, and people with substance abuse problems need to know that they have a disease and not a character defect. At the very least, social work professionals should support their feelings of self-worth by using personfirst language. Users of mental health services face risks from medication and other forms of treatment, and from services that fail to engage them effectively (Stalker, 2003, p. 225). Social workers can help clients living with mental illness better understand what types of medication they are taking, why they are taking them, and what side effects may occur. Also, some medications must be taken at particular times and with particular dietary restrictions, and doctors and nurses may not always fully explain these details to patients. Another area of mental health services that requires advocacy related to human rights is the racial and ethnic disparity in treatment providers. Ten years ago a U.S. Surgeon General report recommended developing a more racially diverse workforce to provide mental health services for racial and ethnic minorities. Still today, however, more mental health social workers representing varied races and ethnicities are needed to meet the needs and numbers of consumers.

Stigma (people with mental and physical challenges)

People with physical and mental challenges and developmental disabilities experience discrimination and injustices. Sometimes the discrimination is subtle and unconscious, as when people talk over the head of an individual in a wheelchair. Other times the prejudice and discrimination is blatant and intended. On a social level, people with physical and mental challenges are often overlooked. For example, they are seldom recognized as a group to be included in a national response to HIV/AIDS, and they are likely to be neglected or abandoned during evacuations in disasters and conflicts due to lack of preparation, planning, and transportation systems. In the case of disability, discrimination is often due to social stigma, which is generally a "stain" on the way a person is perceived that leads him or her to be shunned by others. A famous 20th century sociologist, Erving Goffman noted that "stigma is a process by which the reaction of others spoils normal identity." Goffman identified three forms of social stigma: Visible or outer deformations such as scars, a cleft lip, or obesity— physical or social disabilities Deviations in personal traits, such as mental illness, alcoholism, drug addiction, or having a criminal background Imagined or real traits of an ethnic group, nationality, or religion that are thought to deviate from the prevailing norm, or "tribal stigmas" Regardless of the form of social stigma, the stigmatized person is subjected to discrimination and loses status. Stigmatization can occur at work, in health care, in educational settings, in the criminal justice system, and in one's own family. Disability specialist social workers have observed how stigma affects the behavior of people who are stigmatized. For example, by age 10, most children are aware of disability stereotypes, and children who are members of stigmatized groups are aware of the stereotypes at an even younger age. People who are stereotyped and stigmatized because of their disability begin to act the way that the people who are stigmatizing them expect them to act. Stigma can also shape people's beliefs and emotions, leading them to feel depressed or have low self-esteem.

Forms of elder abuse

Physical abuse: Nonaccidental use of force against an older person that results in physical pain, injury, or impairment; includes hitting, shoving, and inappropriate use of drugs, restraints, and confinement. Serious violence in the form of murder, rape, robbery, aggravated assault, and kidnapping also occurs with older adults. Although most of those who physically maltreat older adults are family members, acquaintances account for 19% of physical maltreatment and strangers for 3%. Emotional or psychological abuse: Speaking to or treating older persons in ways that cause them emotional pain or distress. Verbal forms include intimidation through yelling or threat; humiliation and ridicule; and habitual blaming or scapegoating. Nonverbal abuse is ignoring the older person; isolating the person from friends or activities; or terrorizing or menacing the person. Emotional or psychological abuse is a challenge to detect, and what social workers observe may reflect a lifelong history of harsh-sounding communication. This may take the form of infantilizing or willfully isolating an older adult family member (McInnis-Dittrich, 2014). Sexual abuse: Intimate contact with an older person without the person's consent. Sexual abuse includes physical sex acts and also 481forcing the person to watch pornographic material or watch sex acts. Neglect (and abandonment): Caregivers' failure to fulfill a caretaking obligation. Neglect or abandonment constitutes more than half of all reported cases of elder abuse. It can be active (intentional) or passive (unintentional, based on factors such as ignorance or denial that an older person needs as much care as she or he does). Financial abuse (and exploitation): Unauthorized use of an older adult's funds or property, either by a caregiver or an outside scam artist. Financial exploitation is especially problematic. Noncaregivers may victimize older adults in the form of fraud through investments; charity contributions; car and home repairs; sweepstakes and prizes; home mortgages; health, funeral, or life insurance; health remedies; lottery scams; or telemarketing. Older adults are vulnerable because they often have medical needs, diminished capacity, and a pool of financial resources to exploit.

PTSD

Posttraumatic stress disorder (PTSD): Applies when someone has suffered through an unusually dreadful trauma (e.g., combat, rape, torture, battery, or qualifying catastrophes such as fires, accidents, floods, earthquakes, hurricanes). However, the diagnostic criteria are more descriptive of the symptom-based outcome than of the precipitating event itself. One person may suffer PTSD due to a precipitating event that others might not consider "unusually dreadful." There are numerous variables that can influence whether and to what extent an event or experience is traumatic. Recovery from an accident, traumatic brain injury, or physical abnormality requires specialized treatment and an interdisciplinary team approach.

GI Bills

Provide financial support for education and housing to veterans who have an honorable discharge. The Post-9/11 GI Bill is available to people with at least 90 days of aggregate service on or after September 11, 2001, or individuals discharged with a service-connected disability after 30 days.

recividism

Recidivism, the tendency for former inmates to return to prison, is common because people who have been labeled as criminals find it so difficult to reintegrate into society.

reservist

Reservists are service members who are civilians during peacetime but may be obligated to report for duty during conflicts. They serve in all branches of the military. They tend to be older and married longer than those actively serving in the military. During the war on terror, many reservists were "called up," requiring a sudden disruption in their lives. Monthly income for families of reservists often decreases by more than $1,000 once the reservist leaves his or her civilian job and enters active duty. To serve them, the DoD has put in place family assistance centers and community outreach partnerships with civilian, faith-based, and veterans organizations.

Health care challenges *

Social work advocates and practitioners, along with the general public and all those who work in the health care system, are in the process of grappling with the business and ethical realities of health care, political controversies, the practices of powerful pharmaceutical companies, and the implications of constantly emerging knowledge about the human body and its care.

Substance abuse (numbers/figures)

Some people believe that substance use—in this context the consumption of harmful, potentially addictive substances—should not be a matter for social concern. In reality, the use of some substances causes considerable health and social problems for users. The number one cause of preventable illness and death in the United States is substance abuse, which extends the idea of substance use to include maladaptive patterns of use despite adverse consequences. Each year, more than 500,000 deaths—or 1 in 4—in the United States are attributed to abuse of alcohol, tobacco, or other drugs (Schroeder, 2010). Those deaths include drug overdoses, teen suicides, traffic fatalities, murders, and manslaughter. As illustrated in Exhibit 10.1, substance abuse is also associated with rapes, assaults, burglaries, thefts, and child abuse. And the health care costs of substance abuse are immense when one considers cancer and cardiopulmonary disease from tobacco use, falls and oversedation from misuse of prescription drugs, or bacterial and viral infections (including HIV infection) from injecting illicit drugs.

Elder abuse

Sometimes the stress and demands of caregiving are so overwhelming to family and other caregivers that elder abuse, or maltreatment of an older person, occurs. Physical or mental ailments may cause older adults to be 480more trying companions than usual for loved ones living with them. Older adults may be victimized by noncaregivers as well. As older adults become more physically frail, they are less likely to stand up to bullying or fight back if attacked. They may not hear, see, or think as well as they used to, allowing space for unscrupulous people to take advantage of them. In addition, their retirement funds and benefit checks, unmortgaged homes, and belongings collected over a lifetime make them tempting targets. Only recently have the nature and extent of victimization been recognized as a problem. Unfortunately, older adults across America are being abused and harmed in some major ways. More than half a million occurrences of abuse against older Americans are reported yearly, and millions more go unreported. Those who are most likely to be victimized are unemployed, traumatized by a prior event, getting by with a low household income (less than $35,000 per year), social services clients, in need of assistance with ADLs, or in poor health

Structural Unemployment

Structural unemployment: Caused largely by conditions in the economy that mismatch available jobs and potential workers 595(Diamond, 2013). The skills of potential employees and those required for available jobs are different. Consequently, there are workers wanting jobs and employers needing workers, but because the available workers lack the necessary skills, the jobs go unfilled and the workers remain unemployed. The effective response to structural unemployment is training programs that help workers develop skills that match the work requirements of available jobs

Substance abuse/disorder addiction

Substance use is also linked to mental illness. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines substance use disorder as a mental disorder associated with the consumption of a harmful addictive substance. It is a general classification with a broad range of severity, from mild to severe (American Psychiatric Association, 2013, p. 484). Multiple definitions and criteria exist for the consumption of specific substances such as alcohol and tobacco. The DSM-5 notes that the word addiction is not applied as a diagnostic term in this classification, even though it is commonly used in many countries to describe severe problems related to compulsive and habitual use of substances. The more neutral term substance use disorder is preferred in the United States. Gone is the diagnosis of substance dependence that caused so much confusion in previous editions of the DSM. Substance dependence refers to continued use or craving associated with greater tolerance to a substance, leading to ever-higher doses, and the risk of illness when a person stops using that substance (withdrawal symptoms). Previously, too many people linked the term dependence with addiction, when in fact dependence can be a normal body response to a substance. However, some social workers in this field still use the word addiction to describe more extreme cases. The DSM-5 still includes the term addictive disorders, but it is a new category based on behavioral, not substance, addictions. Gambling disorder is the only addictive disorder in the DSM-5 that is considered a diagnosable condition. This new term reflects recent research that links gambling disorder to substance-related disorders insofar as their brain origin, association with other disorders, physiology, and treatment.

Department of Defense

The Department of Defense (DoD), otherwise known as the Pentagon is the headquarters of all five branches of the U.S. armed forces: Army, Navy, Marine Corps, Air Force, and Coast Guard. The U.S. president is the head of the armed forces; second in command is the secretary of defense, a civilian appointed by the president. The military is extremely hierarchical and bureaucratic. Each branch of the armed forces is headed by a member of the military. Except for the head of the Coast Guard (who reports to the secretary of homeland security) and along with the head of the National Guard, the top leaders of the various branches are known as the Joint Chiefs of Staff. Below them is a hierarchy of smaller and smaller units, down to the squad, which usually consists of 8 to 14 people

Gi bills

The Servicemen's Readjustment Act of 1944, also known as the G.I. Bill, was a law that provided a range of benefits for returning World War II veterans.

parole

The early release of an inmate from prison, supervised by a parole officer. Much like probation, parole specifies conditions (e.g., regular reporting, counseling, drug testing, substance treatment) for offenders.

Health Insurance Portability and Accountability Act (HIPAA)

The main goal of HIPAA was to ensure that people who already had been or were being treated for a health condition could not be discriminated against in receiving health insurance. Although HIPAA has expanded protections for people who belong to group plans, it has not helped people who have individual coverage (Pollitz & Sorian, 2000).

long-term care

The term long-term care, often synonymous with nursing home care, implies that some people require supportive health care for a long time— maybe for the rest of their lives. Family or friends often cannot provide such intensive care themselves; the job is strenuous, laborious, and timeconsuming. By federal law nursing homes with more than 120 beds are required to employ a full-time social worker with at least a bachelor's degree in social work or "similar professional qualifications." Facilities with fewer than 120 beds must still offer social services; however, they are not required to have a full-time social worker on staff. Preferably, a nursing home will hire a social worker from an accredited school of social work who is licensed, certified, or registered within his or her home state. Long-term care social workers make home visits, perform intake assessments, handle discharge planning, facilitate resident and family council meetings, provide educational training, and much more.

Supportive Environment

There is no doubt that where you live, whether in a rural or suburban area or a city, dictates the type and variety of health care available to you. Accessing health care can be a problem when you reside in a remote area. You might not be able to get to a hospital quickly in an emergency. You also might not want to travel long distances to get routine checkups and screenings, and thus you may resort to telehealth services. Rural areas often have fewer doctors, dentists, and social workers, and certain specialists might not be available. People in rural areas of the United States have higher rates of chronic disease than do people in urban areas. They also have higher rates of certain types of cancer, from exposure to chemicals used in farming. Because it can be difficult to access care—especially for the poor and some people of color—health problems in rural residents may be more serious by the time they are diagnosed (Nelson & Gingerich, 2010). The hallmarks of urban settings—size, diversity, density, and complexity— give rise to unique health problems having to do with sanitation and communicable diseases. However, suburban and urban residents also have greater access to advanced technology, screening services, and clinical trials, and they have greater proximity to dialysis facilities, VA hospitals, and long-term care or residential group homes. It is important to note, however, that taking advantage of these health care resources may require some sophistication, money or insurance, and transportation, and thus often requires social work advocacy.

Tricare

Tricare, formerly known as the Civilian Health and Medical Program of the Uniformed Services, is a health care program of the United States Department of Defense Military Health System

Public Accommodation

Uneven access to buildings (hospitals, health centers), inaccessible medical equipment, poor signage, narrow doorways, internal steps, inadequate bathroom facilities, and inaccessible parking areas create barriers to health care facilities. Private companies are becoming increasingly involved within the disability sector. Institutional living has largely been replaced by residential arrangements that accommodate the needs of PWDs, thereby increasing independence and freedom of choice. In ordinary residential areas, more special services areas are being provided. Professional social workers may best maximize client self-determination and service provision for PWDs by being consumer centered, acquiring knowledge about resources and agency services, and advocating for PWDs across practice levels. Social workers empower PWDs best when they attune to what the client wants and refrain from making assumptions or labeling. Because policies that relate to people with physical and mental 356challenges often change, an effective social worker who works with PWDs will be aware of laws, statutes, and local, state, and federal regulations. The National Association of Social Workers regularly updates its published statement that highlights the promotion of self-determination in working with people who have physical or mental challenges. When clients with disabilities require more services than are available, social work advocates can work with the power players to have services for PWDs expanded

Substance abuse and addiction in aging

Unfortunately, when major depression hits, some older adults resort to abuse of alcohol or other substances. Detecting alcohol or drug problems in older adults is challenging. Because of ageism, family members and clinicians are reluctant to ask about it or do not think to assess for addiction. When a substance abuse problem is detected, doctors may fail to realize that even modest amounts of alcohol or drugs can be problematic. Older patients have a significantly reduced ability to metabolize these substances, as well as increased brain sensitivity to them. And the cognitive impairments common with advancing age make self-reporting—as well as selfmonitoring—unreliable. Even small amounts of drug and alcohol use can have serious consequences for older adults. For some who have never used substances or consumed alcohol, substance abuse may start when they begin to experience losses or unwanted transitions. Also, prescription medication use or misuse may be associated with falls in older populations, and substance-abusing older adults may be at higher risk for different cancers and organ damage (Schulte & Hser, 2014). A particular problem is a growing epidemic of alcohol and drug abuse and 471mental illness among the 78 million retiring, aging boomers that have wealth, health, and education (Friedman, 2013). Boomers came of age in the 1960s and 1970s, when illicit drug experimentation with cocaine, opiates, and marijuana was pervasive. Therefore, younger social workers should consider the contextual realities in which baby boomers have grown older and maybe not always wiser. Although alcohol is the most commonly abused drug among older adults, nonmedical use of prescription drugs is a rapidly growing problem. Some studies estimate that nearly 10% of older adults misuse prescription drugs, with serious abuse potential—most often antianxiety benzodiazepines such as Klonopin, sleeping pills such as Ambien, and opiate painkillers such as Oxycodone. When it comes to nonmedical use of prescription medication, women far outnumber men.

Substance abuse and addiction how it affects older adults most commonly abused drug

Unfortunately, when major depression hits, some older adults resort to abuse of alcohol or other substances. Detecting alcohol or drug problems in older adults is challenging. Because of ageism, family members and clinicians are reluctant to ask about it or do not think to assess for addiction. When a substance abuse problem is detected, doctors may fail to realize that even modest amounts of alcohol or drugs can be problematic. Older patients have a significantly reduced ability to metabolize these substances, as well as increased brain sensitivity to them. And the cognitive impairments common with advancing age make self-reporting—as well as selfmonitoring—unreliable. Even small amounts of drug and alcohol use can have serious consequences for older adults. For some who have never used substances or consumed alcohol, substance abuse may start when they begin to experience losses or unwanted transitions. Also, prescription medication use or misuse may be associated with falls in older populations, and substance-abusing older adults may be at higher risk for different cancers and organ damage. A particular problem is a growing epidemic of alcohol and drug abuse and mental illness among the 78 million retiring, aging boomers that have wealth, health, and education (Friedman, 2013). Boomers came of age in the 1960s and 1970s, when illicit drug experimentation with cocaine, opiates, and marijuana was pervasive. Therefore, younger social workers should consider the contextual realities in which baby boomers have grown older and maybe not always wiser. Although alcohol is the most commonly abused drug among older adults, nonmedical use of prescription drugs is a rapidly growing problem. Some studies estimate that nearly 10% of older adults misuse prescription drugs, with serious abuse potential—most often antianxiety benzodiazepines such as Klonopin, sleeping pills such as Ambien, and opiate painkillers such as Oxycodone. When it comes to nonmedical use of prescription medication, women far outnumber men

Cyclical Unemployment

When businesses downsize and lay off workers because of a decrease in demand for goods and services. For example, when banks increased the interest rates on home mortgages and lending funds were limited, the construction of new houses declined. As a result, construction workers were laid off, as were sales clerks in home appliance and hardware stores and employees of companies such as cabinet and carpet manufacturers. The solution to cyclical unemployment is to improve economic conditions and thus increase the need for workers

Continuing care

Wishing to avoid placing the burden of caregiving on others, or not having other family members to depend on in old age, some people secure longterm care insurance, a type of policy that covers basic daily needs over an extended time and helps people cope with the cost of chronic illnesses, such as Alzheimer's disease or various disabilities. The policies typically cover out-of-pocket expenses for assistance with everything from the basics—bathing and dressing—to skilled care from therapists and nurses for months or even years. Long-term care insurance typically covers home care, assisted living, and nursing homes. These are costly services. For example, 1 hour of care from a home-health aide can cost about $20, while the average private nursing home room for someone with dementia costs $87,000 a year or $7,500 a month Neither routine employer-based medical insurance nor Medicare will pay for extended periods of custodial care. Most long-term care policies have a waiting period that works like a deductible. So if a home nursing aide is needed, you may have to wait 90 to 120 days before your benefits start to cover those costs. Only a fortunate few will have long-term care insurance; out of more than 313 million Americans, only about 8 million have any such protection (Zamora, Nodar, & Ogletree, 2013). The low participation rate largely reflects the high cost of long-term care insurance, which averages about $400 per month. A fortunate few will have long-term care insurance, but even that option is looking sketchy as more companies exit the business. Insurance giants such as Prudential and MetLife have recently pulled back from offering long-term care policies. Companies such as John Hancock and Genworth Financial have turned to state regulators, seeking permission to hike premiums dramatically. The 78 million baby boomers now entering retirement are likely to suffer from the lack of long-term care insurance. Many of them have been hurt deeply by the Great Recession, losing good jobs and being "too old" or too discouraged to find new ones, and losing nearly half the value of their retirement funds with little time to earn it back. Many in this generation do not have children to care for them in old age. Few have long-term care insurance; so they are expected to fall so far into poverty trying to provide themselves with paid care that they will qualify for Medicaid, the medical care program for the deeply impoverished.

Health care costs (assisted living)

assisted living facilities about $6000 per month -apartment with maid service -one or more meals and other support services -not covered by medical insurance

Dementia

dementia refers to a group of symptoms that affect social and thinking abilities so severely that everyday functioning is affected. Dementias are classified as mild, moderate, or severe neurocognitive disorders. Some causes of dementia are treatable and even reversible.

eriksons 8th stage

ego integrity vs despair -loss of financial security -loss of role loss of partner, friends -loss of ability to do activites of daily living -loss of ability to function as wish -living with family or attending a day care program -

Palliative care

focuses on relieving and preventing the suffering of patients, whether they are expected to die soon or not. It is provided by physicians, nurses, and social workers who specialize in the relief of pain, symptoms, and stress that accompany serious illness. However, like hospice, palliative care embraces the idea that at the end of life, comfort is more important than continued aggressive treatment. Social workers help people face terminal illness, find peace, and appreciate life

co-occurring disabilities

more than one disability

rehabilitation

rehabilitation services are available to people with physical andmental challenges. Through the Rehabilitation and Services Administration, grants are distributed that help people with mental andphysical challenges get work and live by themselves, as they are provided with supportive counseling services, medical andpsychological assistance, job training, and individualized assistance. Also, clients who are older adults, have a disability, or are determined to be legally blind may receive Supplemental Security Income. The maximum monthly federal payments to these recipients in 2014 were $721.00 for an individual, $1,082.00 for a couple, and $361.00 for an essential person. Exhibit 8.3 indicates the types of services available to people with disabilities and their funding sources. Genetic counseling. Social workers can serve individuals or families as genetic counselors in hospital-based and other settings. Genetic counseling provides information and support to people who have, or may be at risk for, genetic disorders such as sickle cell anemia and Down syndrome. They may also counsel individuals whose illness or disability is based on lifestyle and environment, as with colon cancer. People may seek genetic counseling if they (1) have a personal or family history of a genetic condition or birth defect, (2) are pregnant or planning to be pregnant after age 35, (3) already have a child with a genetic disorder or birth defect, (4) have had two or more pregnancy losses or a baby who died, or (5) have had ultrasound or screening tests that suggest a possible problem. The National Society of Genetic Counselors (n.d.) advocates for improved access to quality genetic counseling and works to ensure that this profession is a recognized and integral part of the health care system. Genetic counseling is effectively accomplished by social workers who focus on psychological and social adjustment. Social workers need to know about the Human Genome Project, genetic testing, the biology of genetic inheritance, psychosocial counseling, values and ethics, and social policy in genetics

Joint Chiefs of Staff

the top leaders of the various branches are known as the Joint Chiefs of Staff

Managed care

type of health care system created to manage, or contain, health care costs. Managed care is offered primarily through the private sector, although Medicaid and Medicare are also a form of managed care. Managed care plans include the following variations