Underrepresented groups in the United States carry a significant and disproportionate burden of specific diseases. For example, while African Americans make up only 12% of the U.S. population, this group accounted for 44% of all HIV/AIDS cases in the United States in 2010 (Kaiser Family Foundation, 2013). In 2010, Hispanics were 1.2 times (Office of Minority Health, 2012) more likely to be obese and almost 2 times (Office of Minority Health, 2013) more likely to be diagnosed with diabetes than their non-Hispanic white counterparts.
There has been much discussion about the type of effective interventions for promoting well-being and improving health outcomes in all Americans, especially for underrepresented groups. Medical social workers excel at providing direct services to individual patients. Given current efforts to shift the paradigm to population-centered interventions, social workers must modify their skills, broaden their perspective, and consider evidence-based interventions.
To prepare for this Assignment, select a public health issue of interest to you (e.g., obesity, diabetes, cancer, HIV/AIDS, mental health).
Eliminating Healthcare Disparities
Tolulope I. Moses
Master of Social Work, Walden University
SOCW-6204: Medical Social 1
Dr Kristie Abbs
Eliminating Healthcare Disparities of Teenage
mental health Issues
Teenagers are the most affected when it comes to mental health challenges. The adolescence phase comes with extreme responsibilities, some which the teenager is not prepared to experience. The phase is a transition between childhood and adulthood and most of the young adults are confused about the path they should follow. For instance, the teenager is confused between clinging to the parents and breaking free to explore the new life stage. Some of the possible mental health challenges are depression and severe anxiety (Blakemore, 2019). An individual contracts the difficulty as a response to activities happening in their primary environment. Most parents attest experiencing difficulties in raising a child in the teenage phase. However, they fail to understand how transitioning to that level where they are experiencing body transformation is extremely confusing and they might contract mental challenges. Their emotional health has been discarded and no individual has expressed the required concerns.
Change is inevitable and it might bring positive and negative reactions. However, most adolescents perceive change as a negative face contracting mental health challenges. Suicide rates have increased in teenagers because of the challenges in trying to live through societal and individual pressure. Moreover, most of the adolescents affected by psychological disorders will be challenged during the adulthood level if it goes untreated or given the proper attention (Kazdin, 2019). The primary way they are affected by such disorders is growth in a negative environment. Children exposed to violence and other forms of abuse will transition in the teenage phase with mental challenges. They will try to incorporate what they have learned in their childhood thus become victims of circumstances. Parents and guardians are more focused on nurturing the physical health and ensure that their children are not constantly sick. However, the emotional and mental health is discarded thus most children face challenges in fighting unknown battles by the parents. The most common battle they experience is struggling to fit within an environment where they are considered different. Experiencing negative instances like discrimination and alienation from their peers will accelerate the damage in their mental health.
Determinants of Mental Health
Various determinants have accelerated the prevalence of mental health damage on adolescents. The first determinant is growth and development in a depressing environment. It is one topic which parents are not ready to discuss especially on how their nurturing style causes teenage mental disorders. The contemporary world parents are extremely busy to try and create a comfortable life for their children and in the process mess their mental health and leave the individual struggling for a lifetime (Levenson, 2017). A depressing environment is filled with physical and emotional abuse. Parental conflicts are inevitable but happening before children’s presence will affect their perception towards a peaceful home. Such an adolescent will develop communication problems when in the adult face since the primary way they have learned to express their thoughts is through anger and shouting or violence. Therefore, the teenage will go through that life level suffering through every type of disorder.
Additionally, the second determinant of the mental health in adolescents is increased peer pressure. Families have different social economic backgrounds and how people are raised. However, the concepts become apparent in the teenage phase where they have learned the gap between wealth and poverty (Sapiro & Ward, 2020). Adolescents raised from poverty struggle in trying to fit in with the extended community. The pressure results from lacking some of the luxurious items which will place them on the same scale levels as their age mates. Therefore, most of the teenagers will feel isolated because they have the minimum requirements which pass them as the present-day teenagers.
Mental disorders can be inherited suppose the parent lived through life without seeking consultation. Such parents and guardians will experience difficulties in bonding or forming healthy relationships with their children (Stephen, 2018). additionally, technology has become a weapon which promotes psychology disorders among adolescents. Parents expose their children to the social media platforms where they experience different forms of abuse. Cyber bullies target such naïve groups and negatively impact their lives through insults and unnecessary negativities. Lowering a teenager’s self-esteem while they are striving to accept the new changes and transitions will only facilitate increase in mental health challenges.
Social work interventions and Teenage Mental Health Challenges
The first implementation I will incorporate as a social worker is creating awareness regarding adolescent mental health challenges. Parents and the extended community need to be educated that not only physical health is significant when raising children. The primary benefit for creating awareness and educating the parents is that they will be more responsible for their children’s mental wellness. For instance, parents and guardians will ensure they provide more peaceful environment and develop excellent relationships with their children. It is the only way adolescents will strike conversations with the parents and express various challenges they experience in school and other places (Rogers & Pilgrim, 2021). Moreover, community awareness will ensure that all members unite to make mental health a priority. The best way is to educate them on the challenges faced during the adolescent phase and ensure that community members collaborate to help children have a smooth transition. Ignorance will be eradicated and will be focused on raising an emotional and mentally healthy generation.
Additionally, adolescents require the mental health education. The strategy is essential because most of such children have minimal knowledge on the condition. Educating them will ensure they understand all the psychological disorders with their signs and symptoms. Therefore, those affected with the disorder will ensure they approach the required organization to get help in the early stages (Blakemore, 2019). Furthermore, adolescents will ensure they form groups which support one another through the challenges experienced in the life level. The primary objective is to minimize the population suffering from the disorder due to parental and community negligence.
Learning institutions need to be part of the implemented programs which will help eliminate the challenges which cause mental health disorders. For instance, schools should develop a section in the curriculum where students are addressed about mental health challenges and how it can be eliminated (Kazdin, 2019). It means that the school administration should develop guidance and counseling officers where children can have adults to confide in regarding their psychology situation. The primary objective for implementing the multiple programs as a social worker is ensuring that children have minimal struggle with their mental health. They deserve to grow and develop in areas which support physical, emotional, and mental wellbeing.
Challenges and interventions.
The first challenge I may encounter when working to implement the interventions is language barriers. Social workers are dispensed to different locations and sometimes I might be sent to a community who has minimal understanding of the common language. It will be difficult to address the mental health challenges and explain the concepts (Levenson, 2017). Moreover, people within such places are not ready to trust a stranger and confide about their children. Therefore, I tend to struggle in convincing the community members about the significance of my services to ensure they nurture a mentally stable future generation. The primary solution for such a problem is ensuring that I find a translator understanding the common language and ensure they help me engage the community. The strategy is significant since it will help them in building trust and opening up about some of the psychological disorders witnessed and treatment approaches taken.
Additionally, another challenge experienced is the stigma and stereotypes created around psychological disorders. Most of the community members believe that children dispensing mental challenges have been cursed and should be excommunicated from society (Sapiro & Ward, 2020). The stereotype has been passed through generations and is extremely challenging to convince the community that most of the disorders are treatable with the best medication plans. Furthermore, it is challenging to convince the potential customers to use their resources and take their children for treatment. Parents believe they need to be tough to ensure that the teenagers grow and develop according to the harsh environment provided.
Social workers also experience financial constraints when moving through communities and creating adolescent mental health awareness. For instance, the social worker is required to develop posters and flyers to be distributed to the community members and help them comprehend the topic. However, it is pretty challenging because the activity is costly and the social worker will be hindered from delivering quality services (Stephen, 2018). The best solution for financial constraints is the government acknowledging the efforts made by social workers and ensuring they have received the much-needed support. The social workers are essential part of the community and should be given the required help for their services.
Advocacy roles a medical social worker in Teenage Mental Health Issue
The primary role of a social worker is to ensure that they help in diagnosing the mental health disorder. Social workers working in the mental health department have been trained to discern the psychological disorders and provide a diagnostic. After that, the social worker will recommend the best medical institution and health professional to offer high quality services. The social worker will reassure the patient to take on the treatment plan ensuring they stick on the recovery path (Rogers & Pilgrim, 2021). Additionally, the individual is obligated to provide follow up activities which will keep the patient busy and focused to reduce the disorder damage on their mental health. Social workers understand that mental health clients require constant attention thus ensure they provide quality services. The primary objective is ensuring that the client is placed in an excellent medical plan and supported throughout their recovery period.
The social worker is obligated to educate parents and guardians on their teenager’s condition. The major goal is to ensure that the adolescent receives full parental support and love to help them through the recovery period. Educating the family is essential since they will be taught on some of the triggers and how they should be avoided. For instance, if the patient’s psychological illness is caused by a violent and abusive environment, the family is educated on the significance of ensuring they maintain peace and serenity (Blakemore, 2019). The social worker and the family will collaborate in ensuring that they push the adolescent to taking their medication and attending all of the guidance and counseling therapy sessions. The social worker will ensure they have received medical attentions despite the financial constraints faced. They respond to all of the raised complaints and ensure that adolescents have an excellent growth and development surroundings thus minimizing psychological disorders cases.
Blakemore, S. J. (2019). Adolescence and mental health. The lancet, 393(10185), 2030-2031.
Kazdin, A. E. (2019). Annual research review: expanding mental health services through novel models of intervention delivery. Journal of Child Psychology and Psychiatry, 60(4), 455-472.
Levenson, J. (2017). Trauma-informed social work practice. Social Work, 62(2), 105-113.
Sapiro, B., & Ward, A. (2020). Marginalized youth, mental health, and connection with others: a review of the literature. Child and Adolescent Social Work Journal, 37(4), 343-357.
Stephan, U. (2018). Entrepreneurs’ mental health and well-being: A review and research agenda. Academy of Management Perspectives, 32(3), 290-322.
Rogers, A., & Pilgrim, D. (2021). A Sociology of Mental Health and Illness 6e. McGraw-Hill Education (UK).
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Journal of Gerontological Social Work
ISSN: 0163-4372 (Print) 1540-4048 (Online) Journal homepage: https://www.tandfonline.com/loi/wger20
Growing Health Disparities for Persons Who Are Aging With Intellectual and Developmental Disabilities: The Social Work Linchpin
Laura M. Robinson , Jason Dauenhauer , Kathleen M. Bishop & JoAnne Baxter
To cite this article: Laura M. Robinson , Jason Dauenhauer , Kathleen M. Bishop & JoAnne Baxter (2012) Growing Health Disparities for Persons Who Are Aging With Intellectual and Developmental Disabilities: The Social Work Linchpin, Journal of Gerontological Social Work, 55:2, 175-190, DOI: 10.1080/01634372.2011.644030
To link to this article: https://doi.org/10.1080/01634372.2011.644030
Published online: 10 Feb 2012.
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Journal of Gerontological Social Work, 55:175–190, 2012 Copyright © Taylor & Francis Group, LLC ISSN: 0163-4372 print/1540-4048 online DOI: 10.1080/01634372.2011.644030
Growing Health Disparities for Persons Who Are Aging With Intellectual and
Developmental Disabilities: The Social Work Linchpin
LAURA M. ROBINSON Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
JASON DAUENHAUER Department of Social Work, College at Brockport, State University of New York, Brockport, NY,
KATHLEEN M. BISHOP Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
JOANNE BAXTER Easter Seals New York, Rochester, NY, USA
Similar to the general population, adults with intellectual and developmental disabilities (IDD) are living into their 70s and beyond. Health care disparities have been well-documented for this vulnerable and underserved population. Social workers are often responsible for assessment, coordination of care, and negotiation of needed services for people with IDD. This article explores the challenges facing social workers in meeting the growing health and social needs of aging adults with IDD and their families. Trends in
Received 31 May 2011; accepted 21 November 2011. Ms. Robinson’s, Dr. Bishop’s, and Dr. Dauenhauer’s efforts were supported by funds
from the Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under Geriatric Education Centers Grant #D31HP08811. This information or content and conclusions are those of the authors/speakers and should not be construed as the official position or policy of, nor should any endorsements be inferred by the BHPr, HRSA, DHHS or the US Government. Ms. Robinson’s and Dr. Bishop’s efforts were also supported by UCEDD Grant #90DD066102 from the US Department of Health and Human Services, Administration on Developmental Disabilities to the University of Rochester.
Address correspondence to Laura M. Robinson, M.P.H., Program in Aging and Developmental Disabilities, University of Rochester Medical Center, 601 Elmwood Avenue, Box 671, Rochester, NY 14642, USA. E-mail: [email protected]
176 L. M. Robinson et al.
social work practice and gaps in education are discussed as they relate to addressing and reducing current health disparities.
KEYWORDS social work, aging, intellectual disability
Over 640,000 adults with intellectual and developmental disabilities (IDD) over the age of 60 were identified in the United States in 2000; this number is expected to double by 2030 (Heller, Janicki, Hammel, & Factor, 2002). The increase in life expectancy can be attributed to improved medical knowledge, access to health care, deinstitutionalization, and better living conditions (Heller et al., 2002), and can be expected to continue.
Increased longevity has presented challenges for service providers who work with people with IDD and their families. Health care practitioners and community services providers often do not have sufficient knowledge and skills to provide appropriate interventions for this unique aging popula- tion due to lack of awareness, research, and formal education within health professions training programs (Ansello, 1992; Fenton, Hood, Holder, May, & Mouradian, 2003; Horwitz, Kerker, Owens, & Zigler, 2001; U.S. Public Health Service, 2001; Wolff, Waldman, Milano, & Perlman, 2004).
Social workers play an important role in meeting the needs of those who are aging with IDD. Specifically, social workers provide assessment, intervention, and advocacy for people with IDD and their families. Although these basic skills are taught within both undergraduate and graduate social work programs, formal education specifically targeting the unique needs of people who are aging with IDD is limited. Therefore, finding social workers adept, or even familiar, in aging and IDD is rare. Thus, the purpose of this article is to bring attention to the limited presence of social workers in the IDD field, the lack of educational opportunities to support the current and future social workers in this field, and the impact of these trends on health disparities experienced by people who are aging with IDD.
IDD, AGING, & HEALTH DISPARITIES
The Centers for Disease Control and Prevention (CDC) defines developmen- tal disabilities (DD) as a diverse group of severe chronic conditions that affects one or more major life activities, such as learning and mobility, as well as independent living. The term intellectual disability (ID) falls under the umbrella definition of a developmental disability and is used interna- tionally to reference a significant cognitive impairment expected to last a lifetime (CDC, 2011).
Health Disparities, IDD, and Social Work 177
Based on US Census data from July 2008, it is estimated that adults over age 65 will grow to 20% of the population (71 million) by 2030 (US Census Bureau, 2011). Of people over age 65, 42% of the civilian, noninstitu- tionalized population has a disability (physical, cognitive or emotional) that impacts the ability to function at home or work (US Census Bureau, 2011). Unfortunately, national health surveillance data in the US for people with IDD are lacking (CDC/National Center on Birth Defects and Developmental Disabilities, 2009; Healthy People, 2010; US Department of Health and Human Services [USDHHS], 2005; US Public Health Service, 2001). Data collection for children with DD is inconsistent throughout the states with different collection processes and even different criteria for diagnosis. After school age and transition to adulthood, the collection of data is even more challenging with little or no information on adults who are not part of for- mal service systems (Shannon & Agorastou, 2006). Social workers are a bridge between people and services. Without this information, it is difficult to determine how many people have a diagnosed IDD, how many are over age 65, what their health needs will be across the lifespan, and what impact their lifelong disabilities and chronic conditions will have on the US health care system, in particular Medicaid and Medicare spending. Understanding the demographics of the community and different subpopulations will assist social workers in advocating for needed services.
Genetics, attitude, environment, lifestyle, and the interaction of preexist- ing lifelong disabilities affect a person’s overall aging experience (Machemer, 1994). Adults with IDD follow similar aging patterns as the general pop- ulation, however with increased severity of a disability, a shortening of life expectancy and/or reduction of quality of life are more likely (Heller, Caldwell, & Factor, 2007). As they age, people with IDD are more likely than the general population to experience cardiovascular disease, sen- sory decline, functional decline, and increasing dependence on paid and unpaid caregivers (Cooper, 1997; Evenhuis, Henderson, Beange, Lennox, & Chicoine, 2000; Haveman et al., 2011; Janicki et al., 2002; Robinson et al., 2010; van Schrojenstein Lantman-de Valk, Metsemakers, Haveman, & Crebolder, 2000). The most common conditions experienced by people with IDD are vision and hearing loss, musculoskeletal decline (e.g., osteoporosis, osteoarthritis), gastro-intestinal conditions (e.g., constipation, reflux), and hypertension. Factors contributing to these health issues include poor diets, decreased physical activities and/or exercise routines, and side effects from medications (Heller, McCubbin, Drum, & Peterson, 2011). People with dis- abilities in the general population are more likely to report poor health status than people without disabilities (Healthy People, 2010; Morbidity and Mortality Weekly Report [MMWR], 2008). In conjunction with a lifelong dis- ability, any additional health conditions significantly compromise the overall health and functional status of aging adults with IDD (Henderson et al., 2009).
178 L. M. Robinson et al.
Diagnostic overshadowing is a term utilized when psychosocial or other health problems are not diagnosed due to a primary diagnosis of IDD (Fisher, 2004; Jones, Howard, & Thornicroft, 2008; Jopp & Keys, 2001; Reiss, Levitan, & Szyszko, 1982). Adults with IDD are known to have a higher risk for a co-occurring mental illness, thus increasing the need for advocacy, ser- vices, and supports that can be provided by a social worker (Chaplin, 2004). The challenges of identifying and diagnosing a coexisting mental illness in the IDD population include the difficulty in distinguishing depression from physical illness or dementia, use of appropriate screening tools, commu- nication challenges, differences in symptom presentation, and determining which of the available services would best meet the needs of the individual with a dual diagnosis (Bourus, 1999). Diagnostic overshadowing is a com- mon problem in the IDD field and one that social workers can advocate to prevent.
Medicaid is the primary form of health care insurance for adults with IDD (Bachman, Tobias, Master, Scavron, & Tierney, 2008; Drainoni et al., 2006; Havercamp, Scandlin, & Roth, 2004). Many health care providers either do not accept Medicaid insurance or limit the number of patients in their practices with Medicaid (Havercamp et al., 2004; Reichard, Sacco, & Turnbull, 2004). As a result, anecdotal evidence suggests that individuals with IDD often access care in clinic settings with long waits for appoint- ments, see newly trained health care providers with limited experience and exposure to people with IDD, and have limited access to after-hours services (Agency for Healthcare Research and Quality, 2011). A lack of sensitivity/experience with this population may result in negative attitudes toward people with IDD from health care professionals who may struggle with communicating at appropriate developmental levels (Ward, Nichols, & Freedman, 2010).
Studies also indicate that adults with IDD are less likely to receive qual- ity preventive health care (Kerr, Richards, & Glover, 1996; Lewis, Lewis, Leake, King, & Lindemann, 2002). Studies by Horwitz, Kerker, Owens, and Zigler (2000) and Lewis et al. (2002) identified limitations in spe- cialty services including mental health care, ophthalmological care, dental services, and preventive screenings for cancer. In another study utilizing focus groups with parents/guardians, self advocates, and community sup- port professionals, health care disparities in four areas were identified: access, knowledge, communication and quality (Ward et. al., 2010). Ward and colleagues (2010) stated that the limited amount of training available and utilized by health care professionals perpetuates these disparities, and thus continues to negatively impact the health of individuals with IDD. Social workers, often as part of an interdisciplinary team, must also receive edu- cation and training on the specific health needs of the IDD population to support their role as the coordinator of appropriate health services.
Similar to general population trends, family members provide a major- ity of informal long-term caregiving for aging adults with IDD (Family
Health Disparities, IDD, and Social Work 179
Caregiver Alliance, 2006; Thompson, 2004) in a home setting. Due to their own advancing age and lack of supportive resources, family caregivers of adults aging with IDD have significant health and social needs (Heller et al., 2007). As these caregivers age, or are no longer able to care for their adult child with IDD, planning for the future is critical (e.g., hous- ing, financial, and related supports). Limited long-term support is evidenced by waiting lists for residential or congregate care settings, which exist in most states (Heller et al., 2002; Lakin, 1998). As the health care needs surpass those that can be addressed at home, competition for placements in long-term care facilities are expected to increase as both adults with IDD and adults without IDD continue to live longer (Parish & Lutwick, 2005). The numbers of older adults that will need services will be at an unprecedented high, thus competition for staff, residential facilities, pro- grams, and other support services may limit what is available and who will have access to these resources. Additional factors that will impact the qual- ity of care for people with IDD include low wages for direct support staff, high turnover rates, and lack of training on aging issues (Larson, Lakin, & Bruininks, 1998; Mitchell & Braddock, 1994; Shakespeare, Iezzoni, & Groce, 2009).
Thus, access to health care for people with IDD that includes regu- larly scheduled preventive services (e.g. mammograms, FOBT); meaningful interaction with informed practitioners; and sufficient time for the discussion of current symptoms, concerns, and/or management of chronic conditions (other than the developmental disability) that is supported by a familiar fam- ily member or staff person would likely begin to close the gap that exists in the health status of adults with IDD compared to the general population. It is clear that health disparities for people with IDD are significant and will continue to grow unless these trends are addressed. Social work has a tra- dition of helping to meet the needs of this population and can be integral to bridging solutions. The following section provides an overview of current social work practice and recent changes that are impacting service coordi- nation in our home state of New York. New York State (NYS) is one of 48 states and DC that operate Home and Community-Based Services (HCBS) Medicaid Waivers to support services to people with IDD (Kaiser, 2011). NYS has one of the highest HCBS expenditures per person in the coun- try, demonstrating a significant need for services (Kaiser, 2011). Despite this high rate of spending for services, social workers are not integral to service delivery in NYS.
CURRENT SOCIAL WORK PRACTICE
Social work is a discipline based upon a strengths-based model of assess- ment and intervention. According to this model, all individuals have the capacity for growth and change (Saleeby, 1996). Social workers use their
180 L. M. Robinson et al.
skills to assist disadvantaged populations in achieving social justice within a variety of interconnected systems. A person is understood within the con- text of his or her environment. As articulated by Russo-Gleicher (2008, p. 131), the values of social work and the field of IDD coincide with one another: “Social workers value rights, dignity, individual uniqueness, self-determination, and client access to resources (National Association of Social Workers, 1999). The field of DD values independence, inclusion, individualization, and productivity (Aventi & Otis, 1994).”
People with IDD and their families are served by social work providers in traditional DD service delivery systems and in social service agencies (Parish & Lutwick, 2005). Social workers are most often responsible for assessment and coordination of care and negotiation of needed services for this population. Care coordination often includes linking families to needed services including housing, health, transportation, education, recreation, and day service programs. Social workers also provide counseling and advocate for needed services and social/public policies that affect individuals with IDD and their caregive
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