Women are amazing, particularly those who are mothers because they take responsibility for everything for their families. Although their housework is not paid, they generally work more than their husbands; they even care for their older parents who have dementia in a personal home. In my practice setting, I observed many family members that visit their loved ones are mostly women who are also the young-old adults. Where are the men? In general, these young-old women frequently contribute their care to the family before the older parents are placed in the personal care home even though they also have their own problems. Such a traditional gendered role and economic burden in gendered workplaces have negative mental and physical health effects to the women’s later life.
In terms of women’s traditional gendered roles, it is meaningful to see the reason that women take more responsibilities for families through a life course framework. Women’s lives cannot be clearly described without considering women’s income inequality, which is a huge factor that affects women’s lives, and where the gendered inequality stems from. Gazso (2010) articulates that mother’s management of their market, such as paid workplace and family experiences, were manipulated by structural constraints in our society, which are imposed by political and economic contexts based on gender, race, sexuality and class. In particular, it is understandable for me why many feminist gerontologists, who focus on studying aging and gender, have paid attention against income inequality for a long time in our society. These feminist gerontologists investigate privilege and oppression by taking look at the life situation of women.
Interestingly, according to Gazso (2010), wage inequality is one of the reasons women are expected to care for their families because women’s unstable jobs help them often quit immediately and take on greater family responsibilities when they face problems in family. This means that men are more likely to be employed on a full time basis with good benefits. In other words, such income inequality in gendered workplaces may account for why women live poorly in their later life.
According to Novak and Campbell (2010), older women traditionally live below the poverty line compared to older men. While “men tend to have more diverse sources of income, including pension income, in retirement in our society” (p. 200), women generally have part-time jobs without pension income, which makes women’s lives insecure in their later life. This perspective supports my assumption that women who suffer from income inequality in their younger life may have negative effects in their later life in terms of both their mental and physical health.
For example, observing older women who are struggling with their insufficient finances in my practice setting, I feel that their emotional well-being status may be influenced by their income which was not enough. Some older women I observed wanted to spend more money for managing their beauty or purchasing necessities, but they could not buy what they wanted. I, therefore, wonder how women’s economic burden in terms of income inequality in younger life affects their later health.
According to Lynch et al. (1994), “men who had experienced economic hardships both as children and adults were twice as likely to die as those whose economic fortunes improved in adulthood. Moreover, the effects on health exerted by persistent economic hardships are over and above those of other [health] conditions that might also be harmful to health” (as cited in Kahn & Pearlin, 2006. p. 27).
Unfortunately, I fail to find studies that clarify how economic burden on gender differences affect older women’s later health. However, based on this perspective, and the idea that explains how many older women live below the poverty line, it is not difficult to assume that older women may face more financial difficulties compared to older men. According to Kahn and Pearlin (2006), economic burden over the life course are more persistently harmful to later health. However, economic burden alone does not affect health. Instead, the health is consistently affected by the ability of economic burden that establishes disturbance in other areas of life.
In addition, these economic stressors may become greater for Black, Aboriginal, and lesbian older women because, as might be expected they experience fewer opportunities for good jobs in their younger lives in light of racism and discrimination in workplaces. It is not difficult to imagine how these women experience greater stress from greater responsibility, and more obligations in terms of their roles in paid and unpaid work. As a social work student, it is important to know how these women’s diverse oppressions or inequality were shaped through their life courses. It is also important to know how I perceive these oppressions and help them improve their strengths, and empower themselves. By examining women’s experiences through the lens of life course, we can help older women reduce their emotional stress. -Eunkyeong
References
Gazso, A. (2010). Mothers’ maintenance of families through market and family care relations. In N. Mandell (Ed.), Feminist issues (pp. 219-246). Toronto: Pearson
Canada Kahn, R. J., & Pearlin, I. L. (2006, March). Financial strain over the life course and health among older adults. Journal of Helath and Social Behvaviour 47(17), 17-31. DOI: 10.1177/002214650604700102
Novak, M., & Campbell. L. (Eds.). (2010). Aging and society: A Canadian perspective. United States: Nelson Education.
Tuesday, March 29, 2011
Tuesday, March 22, 2011
Issues on Care giving
Care givers being oppressed
What is care giving? Care giving can include assistance with personal care needs, such as bathing, dressing, and eating or other activities necessary for independent living, such as shopping, medication management, and meal preparation. Family caregivers do care giving themselves may arrange, supervise, or pay for formal or paid care to be provided to the care recipient.
Canadian study (Fast and Keating cited in the Canadian Nurse journal staff 2000) reported that non paid caregivers of the elderly are saving Canada’s health care system more than 5 billion dollars annually. “Saskatchewan has more than 80,000 informal caregivers helping chronically/terminally ill, disabled or elderly adults and children at home . Three out of every four caregivers are women and as many as 10% of these are older than 75 years of age” (Sawatzky & Fowler, 2003, p. 277). While homecare services are available to assist in care, the burden of care often falls disproportionately on mothers, wives and daughters, who are unpaid for their services. Physical effort combined with lack of support, medical knowledge and sleep can often place the health of caregivers at risk. “It is estimated that 60% of caregivers have a health crisis after 18 months of care giving” (Sawatzky & Fowler, 2003, p. 277). Physical, emotional, social burdens as well as economic costs have been reported as negative consequences to care giving.
Another aspect that some care givers experiences are the emotional, psychological and physical effects. Care givers are prone to suffer from emotional pain. This affects her psychological aspect to the point of not having enough sleep and self-care. Their physical aspect is jeopardized that eventually may develop to some illnesses. These care givers also experiences pain because of the situation they are in. They also experience isolation from their loved ones. Their relationship with the one whom they give care is at stake and as well as their relationship with other members of the family and /or friends. Some of the care giver copes with having deep faith believing that their loved ones will be cured and that their agony will end soon. I am not really surprised about this fact because based on my own experience working in home care and knowing a lot of my friends and relatives, the woman mostly become the caregiver. This caregiver goes through many process of change as they experience great loss where they need to strategize how to cope with the situation that affects their lives.
I think women suffer from great loss in terms of their personal identity is what hurts the most, like change of relationship and lifestyle. One of the women that I know of had to give up her employment because she wants to make sure that her husband is well taken care of. According to her, she is doing it because of her great love for the husband. However, the time came when they were not financially getting enough money to support the family so the woman decided in going back to work and applied respite home care for her husband. Though there is home care, it is not enough support as the home care attendant only stays four hours a day. The woman has to work eight hours a day, so she ended up working part time. In most cases it is always women who needs to adjust in this kind of situation. It is not only their personal lives that are jeopardized but also their financial lives. Of course it is a decision to provide care but who is going to suffer again at the end? Women? “ A women’s issues perspective that underlies many current care strategies defines care giving as a woman’s problem, rather than a societal problem” ( Hooyman et. al, 2002, p. 13). It is clear that in this sense women are being taken advantage of.
It is demeaning to know that although the government is saving money for care givers, it is women who are again oppressed here. For me working at WRHA and assessing whether or not the client needs Health Care Aide support is important but I need to understand what the caregiver is going through. This is an eye opener for me to assess objectively what is good for both the client and the caregiver.
Reference:
Hooyman, N., Cloette, B., Ray, R., & Richardson, V. (2002). Feminist Gerontology and the life course. Gerontology & Geriatrics Education. 22 (4), 3-26.
Sawatzky, J.E. & Fowler-Kerry S. (2003). Impact of caregiving: listening to the voice of informal caregivers. Journal of Psychiatric and Mental Health Nursing. 10, (277-286)
Thursday, March 17, 2011
Old enough to look out for myself!
During one of the group meetings in my practicum the other day, I heard two very similar stories from two of our group members. Despite the similarity of the underlying circumstances, however, the ways in which these individuals dealt with the situation could not have been more different.
In the first story, a gentleman about 80 years old but quite fit informed us that his home-care agency had just called to announce that they were withdrawing his care on grounds that they considered him capable of doing so on his own. The man disagrees with their assessment but claimed that he did not think it worth making a battle out of the issue.
In the second story, a lady of about the same age told us about how she was riding in a handi-transit van when the driver announced that he had to drop her off immediately. This woman is partially deft, and controls her balance problems by walking with a cane. The driver let her off at a bus stop without checking whether even had funds (fortunately she did), if a bus would take her to her home. Compared to the first story, however, this lady is highly self-advocating. She immediately made a formal complaint to the company and has demanded an investigation into matter. At the moment, it looks like an investigation will indeed be carried out.
These stories really got me thinking about the concept of advocacy within the seniors' own world. Very often in social work, we talk about advocating for this group or that group. This is very important, of course, but I think a fascinating subject field may be that of seniors advocating on behalf of themselves and other seniors.
Epstein, West, and Riegel (2000) present an interesting account of an organization called the Joint Public Affairs Committee for Older Adults, which aims to help train seniors to be their own advocates. For myself, I feel that this is a far superior solution to the problem because it honors the self-determination and respect that seniors deserve, not as helpless child figures, but as fully-functioning adults. When the lady in the story above gets her formal apology from the transit company, it will affirm the efficacy and effectiveness that she still possesses and will be a statement of her own relevance. Even representation by the best social worker advocate in the world could never get her that same confirmation.
Clearly, as seniors age, their facilities will inevitably begin to diminish and their ability to be strong advocates for themselves and others will be reduced, as well. Nevertheless, giving seniors the tools to maintain their ability to stick up for themselves for as long as possible seems to me to be one of the best, noblest, and most sustainable long-term solutions to the problem of ageism.
Secondly, the story of gentleman whose homecare was withdrawn provides what I consider to be another interesting comment upon overcoming ageism. Admittedly, this is far from the usual ground we cover, but I would like to introduce it as a discussion point, nonetheless. There is definitely more than one interpretation to be made from this story, however, the one that interests me most is that this particular senior, despite not necessarily going to bat for himself as enthusiastically as the other lady, had the financial resources on hand to suffer only an inconvenience instead of a disaster. As a result, despite the decision of his homecare agency, he avoided being marginalized by this outcome.
As we have often found in in these blogs, seniors are a much-oppressed group, and oppression often comes hand-in-hand with powerlessness. Like it or not, in our modern world, a significant source of power is financial. Donald Trump is 64. Bill Gates is 55. Warren Buffett is 80! Despite each of them technically being senior citizens, none of these individuals is likely to be marginalized anytime soon. These are extreme examples, of course, but the principle is the same. I often worry for the way old-age pension is administered in Canada today, as it is almost a perfectly designed system to marginalize seniors. You pay into the system all your life, then when you retire you hope to heaven that the country actually pays you back as it promised to do. With today's booming senior population, there are serious questions about whether the country can do so. Even if it could easily do so, however, the system still turns seniors from self-sufficient to dependents on the state - and when a person is dependent they find themselves open to all sorts of abuse.
The most important point I want to make is not to blame the victim by suggesting seniors are at fault for their own marginalization - there are, after all, many different avenues of abuse against which finances are no defense. Nevertheless, I think that there is an opportunity here to improve outcomes by reducing risk factors. As a big part of trying to help single teen mothers, we as a society conduct sex education to teens to help avoid unwanted pregnancies. To reduce rates of lung cancer we try to discourage healthy people from smoking. There are many other examples of this; workers safety initiatives, drug and alcohol prevention education, and so forth. Clearly, not everyone in Canada is in a position to save large amounts of money for retirement. Health issues, family demands, and many other factors can make saving difficult. Nevertheless, financial authorities in Canada continue to warn that Canadians who could be saving a great deal more are not doing so (Moore, Robson, Laurin, 2010). I think this is a major potential opportunity for education. How is it that we spend years teaching school children Shakespeare but rarely a single afternoon teaching them about RRSPs, how interest rates really work, the amount of money they need to save for a comfortable retirement, and so on? I think that this kind of education is a must-have, along with sex and health education, as mentioned previously. This is not a one-stop solution, of course, but I think our current system of essentially planning for dependency in old age is a significant cause of marginalization. After all, many years ago seniors were a dominant force in society. They had far more wealth, experience, and political power than did the young. This situation has reversed itself in recent years and I feel strongly that our current pension system has played a role in that reversal. I believe that to a certain extent, this planning for dependency is something that we can and should take steps to address. This sort of education is not likely to be of much use to the current generation of seniors, but tomorrow's seniors are today's youth, and I firmly believe that by building financial literacy and a culture of self-sufficiency today, we may reduce at least, a small fraction of old-age marginalization in the future.
References
Epstein, D., West, A.J., & Riegel, D.G. (2000) The Institute for Senior Action.
Journal of Gerontological Social Work, 33(4), 91-99
Moore, K.D., Robson, W., & Laurin, A. (2010). Canada's looming retirement challenge: Will future retirees be able to maintain their living standards upon retirement? C.D. Howe Institute Commentary, 317, 1-25. Retrieved from http://ideas.repec.org/a/cdh/commen/317.html
In the first story, a gentleman about 80 years old but quite fit informed us that his home-care agency had just called to announce that they were withdrawing his care on grounds that they considered him capable of doing so on his own. The man disagrees with their assessment but claimed that he did not think it worth making a battle out of the issue.
In the second story, a lady of about the same age told us about how she was riding in a handi-transit van when the driver announced that he had to drop her off immediately. This woman is partially deft, and controls her balance problems by walking with a cane. The driver let her off at a bus stop without checking whether even had funds (fortunately she did), if a bus would take her to her home. Compared to the first story, however, this lady is highly self-advocating. She immediately made a formal complaint to the company and has demanded an investigation into matter. At the moment, it looks like an investigation will indeed be carried out.
These stories really got me thinking about the concept of advocacy within the seniors' own world. Very often in social work, we talk about advocating for this group or that group. This is very important, of course, but I think a fascinating subject field may be that of seniors advocating on behalf of themselves and other seniors.
Epstein, West, and Riegel (2000) present an interesting account of an organization called the Joint Public Affairs Committee for Older Adults, which aims to help train seniors to be their own advocates. For myself, I feel that this is a far superior solution to the problem because it honors the self-determination and respect that seniors deserve, not as helpless child figures, but as fully-functioning adults. When the lady in the story above gets her formal apology from the transit company, it will affirm the efficacy and effectiveness that she still possesses and will be a statement of her own relevance. Even representation by the best social worker advocate in the world could never get her that same confirmation.
Clearly, as seniors age, their facilities will inevitably begin to diminish and their ability to be strong advocates for themselves and others will be reduced, as well. Nevertheless, giving seniors the tools to maintain their ability to stick up for themselves for as long as possible seems to me to be one of the best, noblest, and most sustainable long-term solutions to the problem of ageism.
Secondly, the story of gentleman whose homecare was withdrawn provides what I consider to be another interesting comment upon overcoming ageism. Admittedly, this is far from the usual ground we cover, but I would like to introduce it as a discussion point, nonetheless. There is definitely more than one interpretation to be made from this story, however, the one that interests me most is that this particular senior, despite not necessarily going to bat for himself as enthusiastically as the other lady, had the financial resources on hand to suffer only an inconvenience instead of a disaster. As a result, despite the decision of his homecare agency, he avoided being marginalized by this outcome.
As we have often found in in these blogs, seniors are a much-oppressed group, and oppression often comes hand-in-hand with powerlessness. Like it or not, in our modern world, a significant source of power is financial. Donald Trump is 64. Bill Gates is 55. Warren Buffett is 80! Despite each of them technically being senior citizens, none of these individuals is likely to be marginalized anytime soon. These are extreme examples, of course, but the principle is the same. I often worry for the way old-age pension is administered in Canada today, as it is almost a perfectly designed system to marginalize seniors. You pay into the system all your life, then when you retire you hope to heaven that the country actually pays you back as it promised to do. With today's booming senior population, there are serious questions about whether the country can do so. Even if it could easily do so, however, the system still turns seniors from self-sufficient to dependents on the state - and when a person is dependent they find themselves open to all sorts of abuse.
The most important point I want to make is not to blame the victim by suggesting seniors are at fault for their own marginalization - there are, after all, many different avenues of abuse against which finances are no defense. Nevertheless, I think that there is an opportunity here to improve outcomes by reducing risk factors. As a big part of trying to help single teen mothers, we as a society conduct sex education to teens to help avoid unwanted pregnancies. To reduce rates of lung cancer we try to discourage healthy people from smoking. There are many other examples of this; workers safety initiatives, drug and alcohol prevention education, and so forth. Clearly, not everyone in Canada is in a position to save large amounts of money for retirement. Health issues, family demands, and many other factors can make saving difficult. Nevertheless, financial authorities in Canada continue to warn that Canadians who could be saving a great deal more are not doing so (Moore, Robson, Laurin, 2010). I think this is a major potential opportunity for education. How is it that we spend years teaching school children Shakespeare but rarely a single afternoon teaching them about RRSPs, how interest rates really work, the amount of money they need to save for a comfortable retirement, and so on? I think that this kind of education is a must-have, along with sex and health education, as mentioned previously. This is not a one-stop solution, of course, but I think our current system of essentially planning for dependency in old age is a significant cause of marginalization. After all, many years ago seniors were a dominant force in society. They had far more wealth, experience, and political power than did the young. This situation has reversed itself in recent years and I feel strongly that our current pension system has played a role in that reversal. I believe that to a certain extent, this planning for dependency is something that we can and should take steps to address. This sort of education is not likely to be of much use to the current generation of seniors, but tomorrow's seniors are today's youth, and I firmly believe that by building financial literacy and a culture of self-sufficiency today, we may reduce at least, a small fraction of old-age marginalization in the future.
References
Epstein, D., West, A.J., & Riegel, D.G. (2000) The Institute for Senior Action.
Journal of Gerontological Social Work, 33(4), 91-99
Moore, K.D., Robson, W., & Laurin, A. (2010). Canada's looming retirement challenge: Will future retirees be able to maintain their living standards upon retirement? C.D. Howe Institute Commentary, 317, 1-25. Retrieved from http://ideas.repec.org/a/cdh/commen/317.html
Everybody Needs Somebody
Being accepted into the Faculty of Social Work two years ago evoked many different feelings. Mostly, I enjoyed a deep sense of accomplishment; I would finally start working towards becoming a counselor. I have been volunteering at a women's centre offering one-on-one counseling to young women and I felt really comfortable in my role. Offering individual counseling is something I find very fulfilling and I knew that it is what I wanted to do. I think, however, at the same time, it had become my "safety blanket".
A year later, when it was time to submit field practicum preferences, I hoped to continue expanding on what I already enjoyed. Well, either God, destiny, or the universe seemed to have other plans, and I started my field practicum in areas I had never considered before; group work and seniors!
As scary as it seemed to me 9 months ago, today I definitely would not change my experience. With this blog entry, I want to share what I have taken out of the process of group work and how effective and powerful it can be even when professional involvement is minimum.
The group I help facilitate consists of 10 members; 6 women and 4 men. Through the meetings, we have been able to get to know each other and members have shared amazing stories about their pasts and their present circumstances. At the same time, the group members have been able to provide feedback and support to those who need it and the participation from the group facilitators has become minimal as the weeks have gone by.
As in any group, however, we have had moments of confrontation and sometimes rivalry. One occasion that really stands out occurred during our fourth week into the program. As we discussed the importance of feelings and how we often mask them, a group member expressed how he was perceiving a female senior. He said something along the lines of, "I tend to see life in a positive note, but I can't help to notice, that you [referring to the lady] always seem unhappy and depressed". She was overwhelmed by his comment and replied defensively that he didn't know her, and she was going through a lot in her life. She then left the room leaving the group in an awkward silence behind her.
As the facilitator of the group, I met her outside and helped her calm down. I explained to her the importance of coming back into the group and discussing what had occurred. Although she was very hesitant to do so, she at last agreed and reentered the room. When we discussed the problem, it became evident that everyone in the group wanted her to feel better, explain the (harmless and helpful) intent of the comment that had upset her, and offer her support. It was actually a very uplifting experience. I realized that this was the sort of support that can only come from a group of peers, and that one-on-one counseling would never be able to provide it to quite the same level.
In general, I have felt during this practicum that the element of peer support has an important power that small groups or one-on-one situations never really can. For example, if I or another social worker encourage a member to cut down on their addictions, eventually we become just another "mother figure" whose words go in one ear and out the other. When it comes to a large group of peers expressing concern for a person and urging them to modify their behaviour in certain ways, this becomes a voice that is more difficult to ignore. Interestingly, just yesterday, one of our group members who has made major progress in reducing their drinking gave heartfelt thanks to the group for helping provide the motivation and support for doing so. In addition, as Lee and Ayon (2006) note, the inclusion of group members with a similar background helps the group to share problem solving solutions and skills for members with similar issues to work through.
From a broader perspective, there is a major "byproduct" of the group experience that has side benefits in terms of addictions. Fredriksen (1992) points out that the socialization aspect of the group is a huge help in reducing the loneliness and isolation experienced by many seniors, which can lead to direct reductions in the motivation to start or continue addictive behaviour like drinking, gambling, or drug use. This is a powerful result, since it suggests that even a group that achieves no "officially" useful work would probably still be beneficial in many ways simply by bringing otherwise isolated individuals together. Women, especially, may be most affected by this outcome, since they are more likely to outlive male relatives and at higher risk of isolation as a result. This is a main premise of my own practicum work, and it has been very enjoyable and enlightening to see how well this theory plays out in practical experience.
References
Fedriksen, K.I. (1992). North of market: Older women's alcohol outreach program. The Gerontologist, 32(2), 270-272.
Lee, C.D. & Ayon, C. (2006). The power of groups for older adults: A comparative study of European American and Latino senior mutual aid groups. Social Work With Groups, 28(2), 23-39.
A year later, when it was time to submit field practicum preferences, I hoped to continue expanding on what I already enjoyed. Well, either God, destiny, or the universe seemed to have other plans, and I started my field practicum in areas I had never considered before; group work and seniors!
As scary as it seemed to me 9 months ago, today I definitely would not change my experience. With this blog entry, I want to share what I have taken out of the process of group work and how effective and powerful it can be even when professional involvement is minimum.
The group I help facilitate consists of 10 members; 6 women and 4 men. Through the meetings, we have been able to get to know each other and members have shared amazing stories about their pasts and their present circumstances. At the same time, the group members have been able to provide feedback and support to those who need it and the participation from the group facilitators has become minimal as the weeks have gone by.
As in any group, however, we have had moments of confrontation and sometimes rivalry. One occasion that really stands out occurred during our fourth week into the program. As we discussed the importance of feelings and how we often mask them, a group member expressed how he was perceiving a female senior. He said something along the lines of, "I tend to see life in a positive note, but I can't help to notice, that you [referring to the lady] always seem unhappy and depressed". She was overwhelmed by his comment and replied defensively that he didn't know her, and she was going through a lot in her life. She then left the room leaving the group in an awkward silence behind her.
As the facilitator of the group, I met her outside and helped her calm down. I explained to her the importance of coming back into the group and discussing what had occurred. Although she was very hesitant to do so, she at last agreed and reentered the room. When we discussed the problem, it became evident that everyone in the group wanted her to feel better, explain the (harmless and helpful) intent of the comment that had upset her, and offer her support. It was actually a very uplifting experience. I realized that this was the sort of support that can only come from a group of peers, and that one-on-one counseling would never be able to provide it to quite the same level.
In general, I have felt during this practicum that the element of peer support has an important power that small groups or one-on-one situations never really can. For example, if I or another social worker encourage a member to cut down on their addictions, eventually we become just another "mother figure" whose words go in one ear and out the other. When it comes to a large group of peers expressing concern for a person and urging them to modify their behaviour in certain ways, this becomes a voice that is more difficult to ignore. Interestingly, just yesterday, one of our group members who has made major progress in reducing their drinking gave heartfelt thanks to the group for helping provide the motivation and support for doing so. In addition, as Lee and Ayon (2006) note, the inclusion of group members with a similar background helps the group to share problem solving solutions and skills for members with similar issues to work through.
From a broader perspective, there is a major "byproduct" of the group experience that has side benefits in terms of addictions. Fredriksen (1992) points out that the socialization aspect of the group is a huge help in reducing the loneliness and isolation experienced by many seniors, which can lead to direct reductions in the motivation to start or continue addictive behaviour like drinking, gambling, or drug use. This is a powerful result, since it suggests that even a group that achieves no "officially" useful work would probably still be beneficial in many ways simply by bringing otherwise isolated individuals together. Women, especially, may be most affected by this outcome, since they are more likely to outlive male relatives and at higher risk of isolation as a result. This is a main premise of my own practicum work, and it has been very enjoyable and enlightening to see how well this theory plays out in practical experience.
References
Fedriksen, K.I. (1992). North of market: Older women's alcohol outreach program. The Gerontologist, 32(2), 270-272.
Lee, C.D. & Ayon, C. (2006). The power of groups for older adults: A comparative study of European American and Latino senior mutual aid groups. Social Work With Groups, 28(2), 23-39.
Just Between Us
An interesting comment was made in my practicum yesterday, which brought to mind the subject of confidentiality. As part of the support group I facilitate for the Addictions Foundation of Manitoba, I attend a weekly exercise class with a small group of seniors. Yesterday, one group member commented that she had been asked by someone else at the gym what kind of group we were, with one young woman doing exercises with a group of seniors. She had to do some quick thinking to avoid revealing that we were an addictions support group, which would have violated the confidentiality of the group members.
In my practicum, as well, as in all our social work education, the importance of confidentiality is always a major theme. Of course, this value is not specific to social work alone, but is a major consideration in the medical and legal professions, among others. Wynia (2007) suggests several reasons for the high priority we place on confidentiality; in the first place, it reflects our commitment to privacy, and in the second, it provides safe ground for clients to open up and frankly share information with care providers and professionals. Wynia also points out that like other ethical principles, confidentiality is not necessarily an absolute. I found this to be a very interesting argument, and wanted to consider how it could be integrated into our future role as social workers and some of the decisions we may have to make one day.
Actually, this topic really became interesting to me during a discussion with some friends about the duty to report child pornography when this recently became law. This led me to look up the relevant laws in Manitoba, which in this case are found in The Child and Family Services Act. The law makes it clear that anyone who suspects that a child is being abused has a duty to report that information to the relevant authorities. This law applies regardless of confidentiality from professional relationships, except that the lawyer-client relationship is exempt.
Although I definitely agree with this law in principle, it raises two significant problems for me. First, maybe I am interpreting this incorrectly, but if the law formalizes the opinion that child abuse is so terrible that reporting it is more important the doctor-patient or social worker-client confidentiality, then why is the lawyer-client relationship given a special status. The cynic in me wants to argue that perhaps this is because lawyers, but not doctors or social workers, write the laws.
Aside from this, the bigger question for me is about how the line is drawn when it comes to mandatory reporting - that is, violating confidentiality. To me, the basic principle behind this law is that children are such a vulnerable and defenseless group that the government considers their protection to be of the highest priority - so high that it outweighs many of the traditional confidentiality guarantees that people are owed by caregivers. In my practicum, I work with many elderly women who are incredibly vulnerable and in many ways are equally as helpless as children - or even more so. Their physical and emotional strength is sometimes almost non-existent, their cognition is in some cases regressing to a child-like level, and many have little or no financial resources. In short, they could scarcely be more vulnerable to abuse. Even worse, their increasing fragility means that unlike children who parents often find "seem to be made of rubber", senior women may suffer even greater consequences from physical abuse than do children who nature has designed to rebound from the inevitable bumps and blows of tripping on the playground or falling off of the tire swing.
Considering the above, then, if the law is resolved to overrule the principle of confidentiality (except for lawyers) with respect to children, why does it not do so for another intensely vulnerable group in society?
Of course, the pragmatic answer is that confidentiality cannot be lightly dismissed without incurring unintended consequences. As Wynia suggests, no ethical principle is absolute, and confidentiality serves a practical purpose as well as an ethical one. If seniors knew that any mention of elder abuse would mean a mandatory report on the part of their social workers, they are very likely to begin hiding information from their caregivers. Nevertheless, this argument can then be extended to children to point out that many children today are well aware of the dangerous power of the threat "if you hit me, I'll tell my teachers and they'll take us away from you!" The other side of that coin is that many children may fear to tell their teachers, doctors, social workers and so forth about abuse for fear that it may destroy their family. Whether or not this perception is correct is irrelevant, since only an element of doubt in confidentiality is needed to destroy the trust in the relationship.
Ultimately, there are no easy answers to this dilemma, but I really believe that as social workers who advocate and influence policy decisions, this is a very important question for each of us to carefully consider for ourselves.
References
Province of Manitoba. (2010). The Child and Family Services Act. Retrieved from http://web2.gov.mb.ca/laws/statutes/ccsm/c080e.php?ccsm=c80
Wynia, M. K. (2007). Breaching confidentiality to protect the public: evolving standards of medical confidentiality for military detainees. The American Journal of Bioethics, 7(8), 1-5.
In my practicum, as well, as in all our social work education, the importance of confidentiality is always a major theme. Of course, this value is not specific to social work alone, but is a major consideration in the medical and legal professions, among others. Wynia (2007) suggests several reasons for the high priority we place on confidentiality; in the first place, it reflects our commitment to privacy, and in the second, it provides safe ground for clients to open up and frankly share information with care providers and professionals. Wynia also points out that like other ethical principles, confidentiality is not necessarily an absolute. I found this to be a very interesting argument, and wanted to consider how it could be integrated into our future role as social workers and some of the decisions we may have to make one day.
Actually, this topic really became interesting to me during a discussion with some friends about the duty to report child pornography when this recently became law. This led me to look up the relevant laws in Manitoba, which in this case are found in The Child and Family Services Act. The law makes it clear that anyone who suspects that a child is being abused has a duty to report that information to the relevant authorities. This law applies regardless of confidentiality from professional relationships, except that the lawyer-client relationship is exempt.
Although I definitely agree with this law in principle, it raises two significant problems for me. First, maybe I am interpreting this incorrectly, but if the law formalizes the opinion that child abuse is so terrible that reporting it is more important the doctor-patient or social worker-client confidentiality, then why is the lawyer-client relationship given a special status. The cynic in me wants to argue that perhaps this is because lawyers, but not doctors or social workers, write the laws.
Aside from this, the bigger question for me is about how the line is drawn when it comes to mandatory reporting - that is, violating confidentiality. To me, the basic principle behind this law is that children are such a vulnerable and defenseless group that the government considers their protection to be of the highest priority - so high that it outweighs many of the traditional confidentiality guarantees that people are owed by caregivers. In my practicum, I work with many elderly women who are incredibly vulnerable and in many ways are equally as helpless as children - or even more so. Their physical and emotional strength is sometimes almost non-existent, their cognition is in some cases regressing to a child-like level, and many have little or no financial resources. In short, they could scarcely be more vulnerable to abuse. Even worse, their increasing fragility means that unlike children who parents often find "seem to be made of rubber", senior women may suffer even greater consequences from physical abuse than do children who nature has designed to rebound from the inevitable bumps and blows of tripping on the playground or falling off of the tire swing.
Considering the above, then, if the law is resolved to overrule the principle of confidentiality (except for lawyers) with respect to children, why does it not do so for another intensely vulnerable group in society?
Of course, the pragmatic answer is that confidentiality cannot be lightly dismissed without incurring unintended consequences. As Wynia suggests, no ethical principle is absolute, and confidentiality serves a practical purpose as well as an ethical one. If seniors knew that any mention of elder abuse would mean a mandatory report on the part of their social workers, they are very likely to begin hiding information from their caregivers. Nevertheless, this argument can then be extended to children to point out that many children today are well aware of the dangerous power of the threat "if you hit me, I'll tell my teachers and they'll take us away from you!" The other side of that coin is that many children may fear to tell their teachers, doctors, social workers and so forth about abuse for fear that it may destroy their family. Whether or not this perception is correct is irrelevant, since only an element of doubt in confidentiality is needed to destroy the trust in the relationship.
Ultimately, there are no easy answers to this dilemma, but I really believe that as social workers who advocate and influence policy decisions, this is a very important question for each of us to carefully consider for ourselves.
References
Province of Manitoba. (2010). The Child and Family Services Act. Retrieved from http://web2.gov.mb.ca/laws/statutes/ccsm/c080e.php?ccsm=c80
Wynia, M. K. (2007). Breaching confidentiality to protect the public: evolving standards of medical confidentiality for military detainees. The American Journal of Bioethics, 7(8), 1-5.
Saturday, March 12, 2011
It all adds up.
Remember when you were three years old and you were scared of the neighbour's dog, the old man around the corner, or the loud clown at your friend's birthday party? One way or another, it is probably safe to say that everyone has lived through some kind of trauma or other in their life. Now, consider an 80 year-old woman and the kind of trauma that she could have experienced in all her decades of life, with all the implications for treatment and practice that follows.
As an example, my husband's great-grandmother passed away some years ago at the age of 100. Some of the stories that she told my husband from her life really make me realize how easy our lives have become compared to that. For example, when she went into labour with her second child, her husband was extremely sick with a disease that would eventually become fatal. She had to walk over a mile through a blizzard in rural Ontario to a main road where she was able to hitchhike into town and to the hospital. Compared to this, the birth of our own child, with an epidural and a short ride to the comfortable hospital room in Health Sciences Center, almost seems like luxury.
She also told stories of living through both world wars - including seeing German bombers fly over their home in England - with brothers and a son serving in foreign theaters of war, having two husbands who died before her, and seeing their financial position ruined afterward by dishonest creditors.
For sure, these are events I could never relate to. Although I was born in a country that could be said to have been in a "permanent" war for many years, I have never even seen gunfire! In contrast, at my practicum, I have heard women share with us years of physical, sexual, emotional abuse by their partners and close family members. One of the practical issues that always strikes me when I think of these things is how hard it can be, as social workers, to build credibility with people who have lived through these hardships. Compared to their lives, we are little more than children - or even grandchildren - who have lived a pampered existence in a world incredibly different to their own. Even aside from the huge changes in the world since they were young, simply adding up so many more years of pain, stress, and sadness has left them with a higher "total" sum of trauma. Krause (2004) found exactly this kind of cumulative effect of lifetime trauma in a study on older adults.
Since my practicum deals mostly with seniors with substance misuse issues, the treatment for this trauma can sometimes lead to a double threat. Early trauma or stressful events can result in anxiety attacks, depression, and moderate to severe stress disorders later on. Those who seek help from their family doctor are often given a prescription medication to help minimize their suffering. Benzodiazepine such as valium, lorazepam or xanax are the most commonly used drugs to treat anxiety, or panic attacks, however, they are highly addictive and withdrawal effects could become very challenging to handle (Recovery Connection, 2011).
Many seniors struggle with medication dependencies and interactions with alcohol or on going life situations tend to intensify their health problems, family relationships and emotional well-being. Therefore, when we try to give them advice or convince them to make different choices, it is often difficult to understand what they have been through.
One thing in my practicum that I have found to be successful in helping to deal with this disconnect is to find some way - even if it is only a partial way - to find something in common with these seniors, and feelings that we can relate to. For example, even though I have not yet lost a husband or close family member, I have had older relatives pass away and can find a common ground to discuss feelings in this regard with our seniors. Another successful method that I have been able to use is to ask open-ended questions which encourage the client to talk and share their feelings and to listen to their responses with empathy and respect. Not only does this help me understand them better, but just having the chance to talk about these experiences with an interested listener can be therapeutic, as well.
I find that in general, establishing a rapport and mutual respect with these clients can help us get around the massive differences in our lives and get to a point where they are much more willing to listen to us as social workers because they see that we really care about them and have their best interests at heart. In the end, though, it is always extremely important to be aware that we do not let ourselves become condescending or pushy, since this can undo a lot of hard work in building the relationship.
Lastly, one thing that we have to bear in mind is that trauma can have some very unexpected and unpredictable consequences in terms of people's actions. Research has shown, for example, that people and animals who have been subjected to trauma which they are helpless to escape acquire learned helplessness and become incapable of responding in logical ways to even simple problems (Badhwar, 2009). As social workers, we may sometimes become astonished at the decisions that people make that seem to defy all rational explanation. I think it is very important for us to remember that in some cases, trauma can result in people behaving this way, and that trying to deal with the problem using conventional rational means is not likely to succeed.
Badhwar, N.K. (2009). The Milgram experiments, learned helplessness, and character traits. Journal of Ethics, 13, 257-289.
Krause, N. (2004). Lifetime trauma, emotional support, and life satisfaction among older adults. The Gerontologist, 44(5), 615-623.
Recover Connection. (2011). Benzodiazepine. Retrieved from http://www.recoveryconnection.org/drug_index/benzodiazepine.php
As an example, my husband's great-grandmother passed away some years ago at the age of 100. Some of the stories that she told my husband from her life really make me realize how easy our lives have become compared to that. For example, when she went into labour with her second child, her husband was extremely sick with a disease that would eventually become fatal. She had to walk over a mile through a blizzard in rural Ontario to a main road where she was able to hitchhike into town and to the hospital. Compared to this, the birth of our own child, with an epidural and a short ride to the comfortable hospital room in Health Sciences Center, almost seems like luxury.
She also told stories of living through both world wars - including seeing German bombers fly over their home in England - with brothers and a son serving in foreign theaters of war, having two husbands who died before her, and seeing their financial position ruined afterward by dishonest creditors.
For sure, these are events I could never relate to. Although I was born in a country that could be said to have been in a "permanent" war for many years, I have never even seen gunfire! In contrast, at my practicum, I have heard women share with us years of physical, sexual, emotional abuse by their partners and close family members. One of the practical issues that always strikes me when I think of these things is how hard it can be, as social workers, to build credibility with people who have lived through these hardships. Compared to their lives, we are little more than children - or even grandchildren - who have lived a pampered existence in a world incredibly different to their own. Even aside from the huge changes in the world since they were young, simply adding up so many more years of pain, stress, and sadness has left them with a higher "total" sum of trauma. Krause (2004) found exactly this kind of cumulative effect of lifetime trauma in a study on older adults.
Since my practicum deals mostly with seniors with substance misuse issues, the treatment for this trauma can sometimes lead to a double threat. Early trauma or stressful events can result in anxiety attacks, depression, and moderate to severe stress disorders later on. Those who seek help from their family doctor are often given a prescription medication to help minimize their suffering. Benzodiazepine such as valium, lorazepam or xanax are the most commonly used drugs to treat anxiety, or panic attacks, however, they are highly addictive and withdrawal effects could become very challenging to handle (Recovery Connection, 2011).
Many seniors struggle with medication dependencies and interactions with alcohol or on going life situations tend to intensify their health problems, family relationships and emotional well-being. Therefore, when we try to give them advice or convince them to make different choices, it is often difficult to understand what they have been through.
One thing in my practicum that I have found to be successful in helping to deal with this disconnect is to find some way - even if it is only a partial way - to find something in common with these seniors, and feelings that we can relate to. For example, even though I have not yet lost a husband or close family member, I have had older relatives pass away and can find a common ground to discuss feelings in this regard with our seniors. Another successful method that I have been able to use is to ask open-ended questions which encourage the client to talk and share their feelings and to listen to their responses with empathy and respect. Not only does this help me understand them better, but just having the chance to talk about these experiences with an interested listener can be therapeutic, as well.
I find that in general, establishing a rapport and mutual respect with these clients can help us get around the massive differences in our lives and get to a point where they are much more willing to listen to us as social workers because they see that we really care about them and have their best interests at heart. In the end, though, it is always extremely important to be aware that we do not let ourselves become condescending or pushy, since this can undo a lot of hard work in building the relationship.
Lastly, one thing that we have to bear in mind is that trauma can have some very unexpected and unpredictable consequences in terms of people's actions. Research has shown, for example, that people and animals who have been subjected to trauma which they are helpless to escape acquire learned helplessness and become incapable of responding in logical ways to even simple problems (Badhwar, 2009). As social workers, we may sometimes become astonished at the decisions that people make that seem to defy all rational explanation. I think it is very important for us to remember that in some cases, trauma can result in people behaving this way, and that trying to deal with the problem using conventional rational means is not likely to succeed.
Badhwar, N.K. (2009). The Milgram experiments, learned helplessness, and character traits. Journal of Ethics, 13, 257-289.
Krause, N. (2004). Lifetime trauma, emotional support, and life satisfaction among older adults. The Gerontologist, 44(5), 615-623.
Recover Connection. (2011). Benzodiazepine. Retrieved from http://www.recoveryconnection.org/drug_index/benzodiazepine.php
Monday, March 7, 2011
I drink because I'm lonely and I am lonely becuase I drink
Yesterday, as I facilitated the seventh meeting of my support group which is the midpoint of this pilot project, it struck me that that there is a commonality between the reasons many of the women in our group have turned to these addictions. I have heard many stories these seven weeks from six women who struggle with some type of addiction such as gambling, drugs or medication use, and alcohol. I have noted that the women in our group tend to drink or misuse drugs to forget about their unhappiness and the loss of control they are experiencing as they get older.
For example, an 80 year-old member commented about the rich and varied life she enjoyed and major accomplishments she achieved in her life, and I cannot help but notice her sadness as she mentions how she now has to depend on someone to give her a ride whenever she wants to leave the house. Interestingly, I think that one of the reasons she drinks is actually to prove the point that she can do as she likes when it comes to drinking. I find that this bears some similarity to teenage "acting out" despite occurring 60 years since she was a teen. This seems like a very sad irony, especially because whereas the young person will eventually come to learn to express herself in more productive ways as she becomes empowered with age, this lady will only lose more and more of her independence as time goes on - more so if she begins to experience increasing health and/or financial problems. Unfortunately, women with addictions are at higher risks of presenting one or the other if not both.
The question arises for me; what is the appropriate way to treat this behaviour. The depth of loss that an elderly person suffers watching every aspect of their self-sufficiency fade away defies the imagination of a younger person. What we hope and what I learned from other age-specific groups in different provinces of Canada is that by helping seniors socialize and create or form new networks, they will be able to start seeing themselves as being vital and active individuals again at some level and to feel less as is the world has passed them by.
Another lady, an active gambler, has joined us and shared what she gets out of this addictive activity. She gambles to forget the problems she has in her family (specifically with her children) and the frustrations she has with her worsening health. None of the men in the group have commented about such frustrations with their family, which I think has an interesting tie-in to theory. We always hear that women tend to be more defined by their family and relationships than are men. Therefore, if a senior experiences any type of a relationship breakdown, for any reason, a female senior is more likely to be affected at a higher degree compared to a male senior. This has been an ongoing struggle within the program, which as mentioned is based largely on re-socialization. In many cases, we are finding that the distance that has developed between our members and their families is so huge that bridging it seems all but impossible. Even becoming motivated to try to reconnect seems to be beyond the willpower of many.
With many of the seniors on our program, we have found that a significant reason they turn to alcohol is loneliness and isolation. The data supports a similar conclusion; Fredriksen (1992) found that the majority of women admitted to their treatment program were lived in isolation from their friends and family. Also, Pettigrew and Roberts (2008) note that excessive alcohol consumption tends to be positively correlated with isolation in seniors. From my own experience, this seems to be a common theme in the narrative from members of both genders, however, I suspect that women are probably more affected by this problem. From a statistical point of view, it is well known that because women tend to live somewhat longer than men, there is a higher chance that the female spouse will outlive the male. As a result, the woman is more likely to experience living in isolation due to the death of her spouse. As with other cohorts, elderly women also tend to start drinking because of increasing isolation, as noted above. This is something I have definitely noticed in our group. In general, more of the women are alone than the men, since men will tend to end their lives with their spouse still alive, whereas women are more likely to end it alone. Helping our members break free from their isolation, as mentioned previously, is turning out to be more difficult than I would have previously imagined.
The support group was designed to help counteract drinking due to loneliness, however, again and again we are finding that it is not simply a matter of finding or creating opportunities for socialization; the challenge is convincing a group of people who have essentially lost all interest in social interaction that it is worth their time and effort to do so again. This is most dramatically demonstrated for us in the drastically reduced number of seniors who attend any of the group lunches or activities as compared to the number in the program. A major ethical question for us is what level of persuasion is appropriate in our position and at what point we need to respect the wishes of our clients despite how convinced we are that their wishes are working against their best interests.
Finally, a unique issue when it comes to women and alcohol is the increased level of social stigma for women who drink (Fredriksen, 1992). A certain portion amount of this stigma may come from practical grounds, based on the fact that women have the unique ability to give birth to children and are in much greater danger of harming unborn children by drinking. Another part of this stigma, however, may be based only on old stereotypes that in general women are considered to be responsible for the care of others, and that they fail in this regard when they abuse alcohol or drugs. Women are supposed to be giving and sacrificing and therefore drinking is something that we see as being more unacceptably selfish for us than for men. From a practical standpoint, besides continuing to advocate against double-standards, there is much less that we actively do for our clients in this respect.
The lessons for practice that I take away from this discussion are similar to those mentioned above; that in order to treat a person suffering from an addiction, it is necessary to first understand what factors drive them towards the addictive behaviour. In the case of many elderly women, loneliness and isolation are two such factors, and by helping reduce these factors through socialization, we may be able to help dis-incentivize seniors to continue drinking, using drugs, etc.
References
Fedriksen, K.I. (1992). North of market: Older women's alcohol outreach program. The Gerontologist, 32(2), 270-272.
Pettigrew, S., & Roberts, M. (2008). Addressing loneliness in later life. Aging & Mental Health, 12(3), 302-309
For example, an 80 year-old member commented about the rich and varied life she enjoyed and major accomplishments she achieved in her life, and I cannot help but notice her sadness as she mentions how she now has to depend on someone to give her a ride whenever she wants to leave the house. Interestingly, I think that one of the reasons she drinks is actually to prove the point that she can do as she likes when it comes to drinking. I find that this bears some similarity to teenage "acting out" despite occurring 60 years since she was a teen. This seems like a very sad irony, especially because whereas the young person will eventually come to learn to express herself in more productive ways as she becomes empowered with age, this lady will only lose more and more of her independence as time goes on - more so if she begins to experience increasing health and/or financial problems. Unfortunately, women with addictions are at higher risks of presenting one or the other if not both.
The question arises for me; what is the appropriate way to treat this behaviour. The depth of loss that an elderly person suffers watching every aspect of their self-sufficiency fade away defies the imagination of a younger person. What we hope and what I learned from other age-specific groups in different provinces of Canada is that by helping seniors socialize and create or form new networks, they will be able to start seeing themselves as being vital and active individuals again at some level and to feel less as is the world has passed them by.
Another lady, an active gambler, has joined us and shared what she gets out of this addictive activity. She gambles to forget the problems she has in her family (specifically with her children) and the frustrations she has with her worsening health. None of the men in the group have commented about such frustrations with their family, which I think has an interesting tie-in to theory. We always hear that women tend to be more defined by their family and relationships than are men. Therefore, if a senior experiences any type of a relationship breakdown, for any reason, a female senior is more likely to be affected at a higher degree compared to a male senior. This has been an ongoing struggle within the program, which as mentioned is based largely on re-socialization. In many cases, we are finding that the distance that has developed between our members and their families is so huge that bridging it seems all but impossible. Even becoming motivated to try to reconnect seems to be beyond the willpower of many.
With many of the seniors on our program, we have found that a significant reason they turn to alcohol is loneliness and isolation. The data supports a similar conclusion; Fredriksen (1992) found that the majority of women admitted to their treatment program were lived in isolation from their friends and family. Also, Pettigrew and Roberts (2008) note that excessive alcohol consumption tends to be positively correlated with isolation in seniors. From my own experience, this seems to be a common theme in the narrative from members of both genders, however, I suspect that women are probably more affected by this problem. From a statistical point of view, it is well known that because women tend to live somewhat longer than men, there is a higher chance that the female spouse will outlive the male. As a result, the woman is more likely to experience living in isolation due to the death of her spouse. As with other cohorts, elderly women also tend to start drinking because of increasing isolation, as noted above. This is something I have definitely noticed in our group. In general, more of the women are alone than the men, since men will tend to end their lives with their spouse still alive, whereas women are more likely to end it alone. Helping our members break free from their isolation, as mentioned previously, is turning out to be more difficult than I would have previously imagined.
The support group was designed to help counteract drinking due to loneliness, however, again and again we are finding that it is not simply a matter of finding or creating opportunities for socialization; the challenge is convincing a group of people who have essentially lost all interest in social interaction that it is worth their time and effort to do so again. This is most dramatically demonstrated for us in the drastically reduced number of seniors who attend any of the group lunches or activities as compared to the number in the program. A major ethical question for us is what level of persuasion is appropriate in our position and at what point we need to respect the wishes of our clients despite how convinced we are that their wishes are working against their best interests.
Finally, a unique issue when it comes to women and alcohol is the increased level of social stigma for women who drink (Fredriksen, 1992). A certain portion amount of this stigma may come from practical grounds, based on the fact that women have the unique ability to give birth to children and are in much greater danger of harming unborn children by drinking. Another part of this stigma, however, may be based only on old stereotypes that in general women are considered to be responsible for the care of others, and that they fail in this regard when they abuse alcohol or drugs. Women are supposed to be giving and sacrificing and therefore drinking is something that we see as being more unacceptably selfish for us than for men. From a practical standpoint, besides continuing to advocate against double-standards, there is much less that we actively do for our clients in this respect.
The lessons for practice that I take away from this discussion are similar to those mentioned above; that in order to treat a person suffering from an addiction, it is necessary to first understand what factors drive them towards the addictive behaviour. In the case of many elderly women, loneliness and isolation are two such factors, and by helping reduce these factors through socialization, we may be able to help dis-incentivize seniors to continue drinking, using drugs, etc.
References
Fedriksen, K.I. (1992). North of market: Older women's alcohol outreach program. The Gerontologist, 32(2), 270-272.
Pettigrew, S., & Roberts, M. (2008). Addressing loneliness in later life. Aging & Mental Health, 12(3), 302-309
Tuesday, March 1, 2011
If You Want a Successful Collaboration in an Interdisciplinary Team
While I do my practicum, I frequently recognize a resident’s chart is very important for staff members who are working with residents with cognitive impairment. The chart is divided into many sections, such as medical consultations, interpersonal progressive notes, care conferences, new admissions, and all referred documents from the previous place. After I read Bronstein’s (2003) article; a model for interdisciplinary collaboration, I felt that the function of an interdisciplinary team was the same as the chart. Since the chart is written by other professionals, such as physicians, nurses, pharmacists, an occupational therapist, a dietician, recreation facilitators, and a social worker, it provides not only a number of information, but also provides a chance to gain knowledge and experiences from the other professionals’ different perspectives. In other words, the chart is the collection of a record.
However, unlike other professionals’ records, I found that a record seen in a psychosocial aspect is scarce. It was difficult to look at residents’ personal histories, family relationships, or backgrounds that may cause residents’ behaviours or problems. Therefore, when I read Bronstien’s (2003) article, I agreed that an interdisciplinary team was important. As a social work student who attends many staff meetings and care conferences, I think the interdisciplinary team relevantly works together while the chart has some limitations to communicate among other professionals. The diverse opinions and experiences from different professionals are valuable. Then, I wonder what factors can help to establish better collaboration among different professionals. I think flexibility and personal characteristics are big contributors.
The extensive body of literature has suggested the importance of collaborative relationships among different professionals in health care settings. Bronstein (2003) is one of the people who reviewed a number of academic literature, which emphasizes the importance of interdisciplinary teams, and components of successful interdisciplinary collaboration. Bronstein (2003) stresses that it is important to have “interdependence, newly created professional activities, flexibility, collective ownership of goals and reflection on process” (n. p.). to make better interdisciplinary collaboration between social workers and other professionals. Among these factors, I feel that flexibility may be the most critical component to lead successful collaborations.
Mattessich and Monsey (1992) emphasize team members need to think that “they have more to gain than lose by collaboration and an ongoing flow of communication among colleagues” (as cited in Bronstein, 2003). I feel that this thought not only leads an effective communication among interdisciplinary team members, but it also leads “less hierarchical relationships” (Bronstein, 2003) in roles of members. In my practice setting, such flexibility appears when a dietician is absent in a care conference. For example, after a social worker briefly reports a nutrition assessment on behalf of the dietician, and suggests a family member to call back to the dietician, or helps a family member to make an appointment with the dietician in another time.
I believe that this flexibility comes from the value of acceptance of other professionals’ opinions because it is possible when a staff member have trust and interdependent relationships with colleagues. I also agree with Bronstein (2003), who notes such flexibility can come when interdisciplinary team members spend time together formally or informally, when they have oral and written communication among professional colleagues, and when they have respects for colleagues’ opinions and input. Abramson and Rosenthal (1995) state that such flexibility also may come from a belief “reliance on others for certain tasks, and resources allows collaborators to spend their time doing what each knows and does best” (as cited in Bronstein, 2003).
According to the literature, social workers may have a lot of conflicts with other professionals because of their role that advocates clients. Larson (2008) states that the medical model that upholds power to medical professionals is hierarchically structured in health care settings. Under this system, social workers who advocate residents’ needs may meet conflicts because the residents are in passive positions, compared to the medical professionals, who diagnose residents’ health conditions and prescribe treatments. However, Billups (1987) argues that “neither the extreme of perfect unison nor that of unbridled conflict” (as cited in Bronstein, 2003). This means that social workers need to be flexible and understand a situation that they cannot always agree with other professionals. Billups (1987) emphasizes that the social workers can overcome extreme conflicts when they have flexible thinking. I believe that Billups is right because this statement asks a question: how can you be flexible.
To gain a successful collaboration in an interdisciplinary team, I think flexibility is important. However, I wonder how this flexibility can effectively work between other professionals and social workers in the medical model setting, and what can lead them to work better as team members. Bronstein (2003) interprets the review of the literature that self-evaluation and giving feedback may deconstruct conflicts, and may lead to effective communications in interdisciplinary teams.
Bronstein (2003) also states that a professional role, structural characteristics, personal characteristics, and a history of collaboration that influences on interdisciplinary collaboration.
The most interesting parts amongst these factors are about role theory, and personal characteristics. I realize these factors are important for social workers to understand their roles or values when they socialize with other professionals. Their interaction with other professionals should be based on their social work values. I also realize that when social workers have a competent professional role and flexibility, they can reduce their conflicts among other professionals. In addition, I believe that personal characteristics are a strong contributor to collaborative relationships because if social workers work with other professionals in positive thoughts and attitudes, the other professionals will be respectful to them.
References
Bronstein, R., L. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 297-306.
Larson, G. (2008). Anti-oppressive practice in mental health. Journal of Progressive Human Services, 19(1), 39-54.
However, unlike other professionals’ records, I found that a record seen in a psychosocial aspect is scarce. It was difficult to look at residents’ personal histories, family relationships, or backgrounds that may cause residents’ behaviours or problems. Therefore, when I read Bronstien’s (2003) article, I agreed that an interdisciplinary team was important. As a social work student who attends many staff meetings and care conferences, I think the interdisciplinary team relevantly works together while the chart has some limitations to communicate among other professionals. The diverse opinions and experiences from different professionals are valuable. Then, I wonder what factors can help to establish better collaboration among different professionals. I think flexibility and personal characteristics are big contributors.
The extensive body of literature has suggested the importance of collaborative relationships among different professionals in health care settings. Bronstein (2003) is one of the people who reviewed a number of academic literature, which emphasizes the importance of interdisciplinary teams, and components of successful interdisciplinary collaboration. Bronstein (2003) stresses that it is important to have “interdependence, newly created professional activities, flexibility, collective ownership of goals and reflection on process” (n. p.). to make better interdisciplinary collaboration between social workers and other professionals. Among these factors, I feel that flexibility may be the most critical component to lead successful collaborations.
Mattessich and Monsey (1992) emphasize team members need to think that “they have more to gain than lose by collaboration and an ongoing flow of communication among colleagues” (as cited in Bronstein, 2003). I feel that this thought not only leads an effective communication among interdisciplinary team members, but it also leads “less hierarchical relationships” (Bronstein, 2003) in roles of members. In my practice setting, such flexibility appears when a dietician is absent in a care conference. For example, after a social worker briefly reports a nutrition assessment on behalf of the dietician, and suggests a family member to call back to the dietician, or helps a family member to make an appointment with the dietician in another time.
I believe that this flexibility comes from the value of acceptance of other professionals’ opinions because it is possible when a staff member have trust and interdependent relationships with colleagues. I also agree with Bronstein (2003), who notes such flexibility can come when interdisciplinary team members spend time together formally or informally, when they have oral and written communication among professional colleagues, and when they have respects for colleagues’ opinions and input. Abramson and Rosenthal (1995) state that such flexibility also may come from a belief “reliance on others for certain tasks, and resources allows collaborators to spend their time doing what each knows and does best” (as cited in Bronstein, 2003).
According to the literature, social workers may have a lot of conflicts with other professionals because of their role that advocates clients. Larson (2008) states that the medical model that upholds power to medical professionals is hierarchically structured in health care settings. Under this system, social workers who advocate residents’ needs may meet conflicts because the residents are in passive positions, compared to the medical professionals, who diagnose residents’ health conditions and prescribe treatments. However, Billups (1987) argues that “neither the extreme of perfect unison nor that of unbridled conflict” (as cited in Bronstein, 2003). This means that social workers need to be flexible and understand a situation that they cannot always agree with other professionals. Billups (1987) emphasizes that the social workers can overcome extreme conflicts when they have flexible thinking. I believe that Billups is right because this statement asks a question: how can you be flexible.
To gain a successful collaboration in an interdisciplinary team, I think flexibility is important. However, I wonder how this flexibility can effectively work between other professionals and social workers in the medical model setting, and what can lead them to work better as team members. Bronstein (2003) interprets the review of the literature that self-evaluation and giving feedback may deconstruct conflicts, and may lead to effective communications in interdisciplinary teams.
Bronstein (2003) also states that a professional role, structural characteristics, personal characteristics, and a history of collaboration that influences on interdisciplinary collaboration.
The most interesting parts amongst these factors are about role theory, and personal characteristics. I realize these factors are important for social workers to understand their roles or values when they socialize with other professionals. Their interaction with other professionals should be based on their social work values. I also realize that when social workers have a competent professional role and flexibility, they can reduce their conflicts among other professionals. In addition, I believe that personal characteristics are a strong contributor to collaborative relationships because if social workers work with other professionals in positive thoughts and attitudes, the other professionals will be respectful to them.
References
Bronstein, R., L. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 297-306.
Larson, G. (2008). Anti-oppressive practice in mental health. Journal of Progressive Human Services, 19(1), 39-54.
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