Clinical and Direct Practice

Adult Protective Services (APS) are empowered by states and local communities to respond to reports and cases of vulnerable adult abuse, neglect, and self-neglect. While incorporating legal, medical, and mental health services, APS programs are part of the social services delivery system and incorporate principles and practices of the social work profession.

Social workers address older adult issues at all levels of service planning, policy-making, and delivery and across a wide range of community and institutional settings. While various models of practice intervention with older adults exist, more recently the focus is on the integration of micro and macro strategies with an emphasis on strength-based perspectives to geriatric social work practice. The older adult population will expand dramatically and become increasingly culturally, racially, and ethnically diverse in the future and social work services will need to be sensitive to the variety of issues faced by a more heterogeneous and sophisticated older adult population.

Despite high levels of functioning among older adults, chronic health conditions lead to impairment and the need for help. Family members provide most of the assistance; yet formal services such as in-home personal and homemaker services, congregate and home-delivered meals, adult day services, employment and educational services, transportation, nursing homes, assisted and supportive living facilities, legal and financial services, and case management are available. Even with the growing number and type of services, unequal access and uneven quality persist. In these settings, social workers develop and administer programs, provide clinical care, offer case management and discharge planning, and contribute to policy development.

Transitions in care occur when a patient moves from an institutional setting, such as a hospital or nursing home, to home or community, often with the hope or expectation of improving health status. At the very least, patients, clinicians, and caregivers aim to achieve stability and avoid complications that would precipitate a return to the emergency department (ED) or hospital. For some groups of vulnerable people, especially the very old and frail, such transitions often require specific, targeted coaching and supports that enable them to make the change successfully. Too often, as research indicates, these transitions are poorly executed and trigger a cycle of hospital readmissions and worsening health, even death. In recognizing these perils, organizations have begun to see that by improving the care transition process, they can improve health outcomes and reduce costs while ensuring safety, consistency, and continuity. While some of this improvement relies on medical care, coaching, social services and supports are often also essential. Lack of timely medical follow-up, transportation, inadequate nutrition, medication issues, low health literacy, and poverty present barriers to optimal health outcomes. By addressing social and environmental determinants of health and chronic disease self-management, social workers who make home visits or other proven timely interventions to assess and coach patients and their caregivers are demonstrating real results. This article describes care transitions interventions, research into barriers and opportunities, and specific programs aimed at improvement.

This entry explains who gay men are, how gay identity constructions have evolved since their inception, and how they continue to evolve. It also describes the health and mental health problems that gay men may present to social work practitioners. In addition, it identifies several social policies that are relevant to gay men. The entry argues that a systemic perspective that takes into account the social, political, and cultural influences on gay men is necessary for understanding the problems that such men commonly experience.

Social work in health care emerged with immigration and urbanization associated with industrialization, and the resultant shift from physician visits to the patient's home and workplace to hospital-centered care. This change is alleged to have resulted in a loss of the doctor's perspective of the psychosocial influences on physical health. Originally, some nurses were assigned the function of addressing this loss. But eventually, the function became recognized as that of a social worker. From its beginnings in the general hospital setting in the late 1800s, social work in health care, that is, medical social work, has expanded into multiple settings of health care, and the role of the social worker from being a nurse to requiring a Master's Degree in Social Work (MSW) from a university. However, the broad function of social work in health care remains much the same, that is, “to remove the obstacles in the patient's surroundings or in his mental attitude that interfere with successful treatment, thus freeing him to aid in his own recovery” (Cannon, 1923. p 15). Health care social workers are trained to work across the range of “methods,” that is, work with individuals, small groups, and communities (social work “methods” are called “casework”, “group work” and “community organization”). They work to assist the patient, using a broad range of interventions, including, when indicated, speaking on behalf of the client (advocacy), helping clients to assert themselves, to modify undesirable behaviors, to link with needed resources, to face their challenges, to cope with crises, to develop improved understanding of their health-related thought processes and habits, to build needed self confidence to do what is required to help themselves deal with their health problem, to gain insight and support from others who are in a similar situation, to gain strength from humor, or from a supportive environment, and through spiritual experience, and from practicing tasks that are needed to deal with their health-related problems or from joining forces with others in the community to modify it in the interest of improved health status for all, or to gradually restore a sense of stability and normalcy after a traumatic experience. Most important of all, perhaps, is the “helping relationship” between client and social worker, which needs to be one of total understanding and acceptance of the client as a person. A sizable portion of the U.S. population lacks financial access to health care, where health care is regarded as a privilege rather than a right, as it is seen in all other industrial nations (except South Africa). Current trends in the U.S. health care system reflect efforts to control rising health care costs without dealing with the “real problems,” which are: (1) the lack of a single-payer health care system and: (2) the lack of focus on “public health.”

Home visiting and home-based intervention are two strategies used by social workers when working with individuals or families in direct practice. The basic rationale for home-based work is the benefit to social workers’ assessments and understanding of clients, as well as the benefit of more relevant practice with families who are seen in the setting where difficulties are occurring. Home-based interventions have been shown to be effective in improving health and decreasing family discord. When visiting the home, the social worker has the added responsibility of respecting the privacy of families as a guest in their homes.

Although the terms older adult and senior citizen are commonly defined as individuals 60 years and above, later adulthood contains various life-course phases and developmental periods. The “young-old,” defined as individuals in the age range of 60–75 years, often experience various health, social, and economic transitions. Both the individual and family systems must negotiate some of the concomitant changes that accompany the journey into later life. Therefore, this first decade of older adulthood is one that can simultaneously be enjoyable, exciting, demanding, and stressful for aging persons and their family.