Individual Programmatic Assessment

1. Individual Programmatic Assessment: Professional Skills


Individual Programmatic Assessment: Professional Skills



Angela Hufnagel-Kissinger
BSHS/465
09/28/2015
Instructor Regina Peacock


At Risk Elderly Adults

Later in life, elderly adults have limited prescribed roles in our social society. Majority are retired (from employment) with no significant responsibilities such as young children. According to the life-course theory transitions are associated with change in the roles and, possibly, changes in the elderly personal identity (Elder 1995; Moen 1995). The main transition in later life is the move from independent living (housing) to congregate living (dependent housing) community based living. In today's days older Americans are choosing to move into a more retirement community setting (environment) (CCRCs) instead of living independently. This type of facility, offer seniors with an independent living style with the opportunity of a variety of services and resources. Such as physical fitness, social activities, arts and crafts, medication modification, and 24 hour health services (Sherwood et al. 1997).
There is several changes older adults' experience. For example declining health, lack of support from family and friends, motivation to socialize, departure of a significant other or child, wrinkles, shorten of the bones, arthritis, or transiting from a transitional setting residence (mixture) to an all older community residence. This tends to disrupt both their social relationships, and individual social identity. Early role theory emphasized that life roles and role identities reflect individual positions in the social environment (Linton 1936; Parsons 1951).
Throughout our lives we experience several stages from infancy, child, adolescent, adult, and late adulthood. In the late adulthood stage of life people experience things from a whole new perspective compared to their younger years. In later adulthood they tend to focus more on what they have or have not accomplished throughout their lives, or what they would still like to accomplish before the end of their days. Late adulthood starts around age 65 around this time things change such as importance of health, retirement concerns, and physical appearance. As our body's age we experience things we have never experienced or felt before, and sometimes this takes a hold on our acceptance of aging (mentally). Transition into late adulthood can be a wonderful and exciding experience, especially when planned and prepared correctly.
In order for us to become caring individuals it requires commitment to ourselves, and also self-care. During this stage if we maintain a superficial, narcissistic ambition we will have a negative impact on people around us whether family, friends, or co-workers. In the elderly stage people will illustrate social values, discipline, productivity and creativity. This stage in life also display love expression (other than sexual contact), maintain healthy patterns, raised their children to become responsible adults, adjust to physical changes (in middle age), and also develop a sense of unity (with relationships) with their spouse. According to Erikson late adulthood completes our life cycle, it starts around the time individuals enter into retirement. Erikson believed the first life stage is (trust), and the last stage is (integrity).
Inter-personal Skills
Interpersonal communication is a critical tool for life adjustment; it links us to our social environment. As we age, our communication skills change subtly at least in part of changes in physical health, cognitive decline, and depression. Some aging adults experience physiologic changes in hearing, and speech processes. For example voice tremors, pitch, speaking rate, loudness etc.… There are several important skills required when working with our elderly population such as communication, including sensitive listening and awareness. Below are some examples of interpersonal skills necessary for social workers to practice when working with the elderly population (Social work with old people, 1990).
Communication and awareness of non-verbal communication
Taking time to assess needs, starting where the older person is and would like to be.
Supporting people with managing crises that arise through loss and change, e.g. bereavement, change in physical or mental health
Supporting people whose lives are constrained by illness and disability
Provide empathy not sympathy for the elderly adult
Generating and organizing resources for their older generation
Working with other professionals in networking with other agencies
Helping the helpers, including careers and colleagues in understanding the aging process
Combating ageism.
Personal and Professional Qualities
Personal and professional qualities when working with the elderly population consist of many factors such as; being responsible, supportive, caring attitude, respectful, sensitive, patient, understanding, good people skills, flexibility, and encouragement.
Responsible- Human service professionals must at all cost be responsible for those who are not responsible enough to take care of themselves. Our aged population needs to feel sure in the knowledge that they will be responsibly looked after.
Supportive- Aged care professionals must make sure they are capable of providing enough support to their client's special needs.
Caring Attitude- It is extremely important for aged care professionals to be caring and compassionate towards their clients.
Respectful- Human service professionals must always be respectful towards their client's and as an aged care worker they must always remember a give "respect and take respect" policy.
Sensitive- When working with the elderly population, professionals must be sensitive and understanding of their clients special needs.
Patient- Patience is a virtue when working with the elderly population.
Understanding- Understanding the elderly population is an influential factor when providing them care.
Good People Skills- Good people skills are very important for any healthcare professional, and in the aged care, relating to others assumes even more importance.
Flexibility- It is very important to practice flexibility and accommodation especially when working with the elderly population.
Encouragement- Honest encouragement work wonders in daily life and the same applies in the case of elderly care.
The things mentioned above will assist human service professionals in successfully working with the elderly population. As professionals, we must remember to be sensitive enough to lend a sympathetic ear to their issues; this would provide the elderly population with some relief.
Differential Treatment
Sometimes differential treatment is required with the elderly population. Differentiating between medical and psychological disorders can be challenging for any clinician because psychiatric and medical condition can have overlapping symptoms that mimic each other. This differentiation in older adults is further complicated by higher rates of strokes, nutritional/metabolic changes related to aging, multiple medications, possible increasing amounts of chronic pain, infections, reduced tolerance for drugs and alcohol, perceived stigma and a general lack of awareness associated with mental illness and experiencing multiple losses (Zarit and Zarit, 2007). Due to these complicating factors, it is important for any clinician to be able to distinguish between medical and psychological disorders, especially since effective treatments differ between these types of disorders. Rapport building is an essential component to assessment especially when working with elderly clients. Elderly adults may not up issues spontaneously because they are embarrassed, do not want to complain or be a burden, or just simply do not know that what they are experiencing is a problem and they need treatment.
Strategies to Improve Skills
There are several strategies human service professionals can imply to improve their skills when working with the older population. Such as performance monitoring, impact evaluations, and process evaluations. Performance monitoring focuses on which kinds of outputs and outcomes indicators are appropriate for specific target populations (in this case the elderly population). Impact evaluations spells out how and for whom certain services are expected to create specific changes/benefits. Process evaluations helps to identify expectations of how the program should work this can be used to assess the deviations in practice, why these deviations have occurred, and how the deviations my affect the programs outputs. One strategy that can help me improve my professional skills is monitoring service quality by collecting data on the satisfaction of serviced clients. Another strategy would be beneficial is keeping up with reports on the programs efficiency, effectiveness, and productivity by assessing the relationship between the resources used (program inputs) and the outputs and outcome indicators. Below are other strategies that can help human service professionals in improving their skills.
Continually explore and reflect on views of elderly adults.
Challenge misperceptions and stigma – Pathology is not a normative part of aging.
Recognize that psychiatric and medical symptoms can mimic, overlap, interact, and impact each other.
Adopt a bio-psycho-social framework toward assessment and treatment.
Routinely screen for depression, suicide and substance use.
Be vigilant for delirium.
Utilize caregivers as appropriate and recognize that they are resources and part of the client system.
Potential Challenges
There will always be potential challenges when working with the elderly population. Elderly people are living longer than ever before, and the number of older people reporting very good health and improvements in physical functioning (e.g., the ability to walk a mile or climb stairs) has increased in recent years. When working with elderly clients it can be especially challenging because it raises very personal issues about one's future. On one hand, this can be a joy because we are able to work with incredible role models, many of whom display tremendous strength and wisdom. On the other hand, we face the enormous struggles of the frail elderly who face economic, physical and emotional hardships. Elderly care workers has a significant role to play in supporting older adults, addressing barriers, continued productivity, and active aging through counseling, substance abuse treatment, caregiver support and, in general, facing down and turning around the pervasive ageism in society. Our elderly population requires comprehensive services for health, mental and behavioral health, housing, disabilities, economic challenges and other support and social services in both rural and urban environments. Below are other challenges the elderly population faces.
Depression is the most common mood disorder among older adults.
20% of depressed patient endure a chronic course with no remission
Co-morbidity is high among older adults with depression and another medical or neurological disorder.
Elderly adults may be more willing to consult with their primary care physician than with a mental health professional.
Hospital stays are twice as long for older adults who have co-morbid depression.
The social policy has the potential to affect older adults (Americans) in many ways such as Medicare, Medicaid, social security, Older Americans Act, unemployment insurance, retirement plans, affordable health care, senior program funding cuts, long-term care, access to preventive benefits, and most important hunger and food insecurity. All of these things can affect social policy for our older adults (elderly community); we must, as aging Americans protect these types of programs for the next elderly generation (this can be very challenging).
Conclusion
In conclusion, social workers bring a unique mix of skills and expertise to situations of complexity, uncertainty, conflict and risk - all of which arise in their work with older people. Effective social work with older people requires both practical skills, such as securing and coordinating resources, and 'people' skills, such as sensitive communication and listening skills, taking time, moving at the individual's pace, supporting families and collaborating with colleagues in a multi-disciplinary setting. Aging is a wonderful and beautiful thing it provides a sense of wisdom, respect, and acceptance of a fruitful fulfilling life. Aging gracefully with a significant other, family, and friends is one of life's best rewards. It is very important for us as a society to acknowledge seniors has and still contributions to our social environment. The beginning of life (innocent) is just as important as the end of our life's journey (a peaceful death).













Peer-Reviews
Housing and service for the elderly in Denmark
Abstract: During the past fifteen years, Denmark has been forced to develop new attitudes towards old age and new ways of housing and servicing the elderly, due not only to the increasing number of elderly but also because of societal change. Institutional care is insufficient, and nursing homes are no longer built. "Staying home as long as possible" is the policy, supported by flexible and efficient home help service and nursing care, which is given to all according to their needs, free of charge. Every elderly person has the right to independent living. In accordance with the Housing Act for the Elderly, which sets a standard for a self-contained dwelling, a variety of housing is being built, ranging from co-housing with opportunities for mutual support and exchange of resources among the elderly themselves to special housing for frail elderly. Denmark will face the next boom of elderly in about fifteen years. To ensure that elderly people can live independent lives, using their own resources, the challenges ahead are to remove the societal barriers hindering independent living, to develop a greater variety of housing options and to ensure access to services. The housing and care policy for the elderly depends on the view of old age and the chosen model of ageing. [PUBLICATION ABSTRACT]
Lindstrøm, B. (1997). Housing and service for the elderly in Denmark. Ageing International, 23(3-4), 115-132. http://dx.doi.org/10.1007/s12126-997-1009-y
Psychotherapy for the elderly: Public opinion
Abstract: Examined beliefs about the benefits that the elderly derive from psychotherapy. 414 Ss' (aged 17–81 yrs.) completed a questionnaire about the incidence of psychological problems, the incidence of 4 personality disorders (antisocial, compulsive, dependent, or schizoid), and the value of psychotherapy for adults 20–80 yrs. old. Ss' of all ages held strong biases against psychotherapy for older adults. Ratings of the value of psychotherapy and the benefits that clients could derive from psychotherapy decreased steadily with increasing target age. Such biases contribute to the limited use of psychotherapy among the elderly. (Psych-INFO Database Record (c) 2013 APA, all rights reserved)
Zivian, M. T., Larsen, W., Gekoski, W., Knox, V. J., & Hatchette, V. (1994). Psychotherapy for the elderly: Public opinion. Psychotherapy: Theory, Research, Practice, Training, 31(3), 492-502. http://dx.doi.org/10.1037/0033-3204.31.3.492
Designing service delivery systems: Lessons from the developments
Abstract: A study concludes that the efforts of interest groups and policy advocates are constraining health and social service organizations from responding to changing client needs and expectations. The study concludes that these constraints have created a dynamic where trying harder to make the delivery system work has become a driving force in efforts to improve service delivery. Yet despite continued efforts, improved functioning of delivery systems remains an elusive ideal. Using the example of the delivery services to the elderly, it is argued that unless policy makers and advocates begin to focus on the dynamic relationships among organizations, inter-organizational fields, and service delivery networks, systems development will continue to be an unobtainable and perhaps even a dysfunctional goal.
Myrtle, R. C., & Wilber, K. H. (1994). Designing service delivery systems: Lessons from the develops. Public Administration Review, 54(3), 245. Retrieved from http://search.proquest.com/docview/197163961?accountid=458
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Zarit, S and Zarit, J. (2007). Mental Disorders in Older Adults: Fundamentals of Assessment and Treatment. (2nd Ed.). Mood and Anxiety Disorders.




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