Search

Introduction to the special issue on Medicare Inclusion of Counselors: Preparing the Counseling Workforce to Serve Older Adults. [ABSTRACT FROM AUTHOR]

Suicide in later life is a pressing public health concern, which has likely been exacerbated by the COVID-19 pandemic. Many older adults who need mental health treatment do not have access to necessary services and training for mental health providers to support older adults experiencing suicidality is limited. One solution is developing interventions based in a public health approach to suicide prevention, whereby natural helpers who provide community services are mobilised to respond to older persons-at-risk. Home-delivered meal (HDM) services, for example, are one effective means to reach older adults who are isolated due to being homebound and may be instrumental in preventing suicide. This study examined the experiences of 20 HDM volunteers who received Applied Suicide Intervention Skills Training (ASIST), an evidence-based suicide intervention programme. Phenomenological analysis yielded findings centred on three areas demonstrating the impact of the ASIST training on HDM volunteers: putting asist skills into practice; response to ASIST skills; and role transformation. Implications for integrating suicide prevention efforts with HDM services and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

Although advocacy is a priority for counseling professionals, little is known about counseling advocates' participation in the legislative advocacy process. Recent legislation to address the opioid crisis allowed counseling advocates to provide public comments to advance counselor inclusion in the Medicare program. A thematic analysis of 548 public comments provided on behalf of the counseling profession yielded four categories: advocacy on behalf of (1) the proposed rule change; (2) broader Medicare inclusion; (3) the proposed rule change with an additional request for broader Medicare reimbursement; and (4) no clear advocacy. Subthemes included increasing access to care, qualifications necessary to provide care, and the urgency of the opioid epidemic, among others. Implications for the counseling profession and counselor advocacy are discussed. [ABSTRACT FROM AUTHOR]

Mental health conditions are relatively common among Medicare beneficiaries. Yet, Medicare provider eligibility was last updated in 1989, raising concerns about beneficiaries' access to mental health care in the United States. Beneficiaries are currently restricted from accessing mental health services provided by licensed professional counselors and licensed marriage and family therapists. Little is known about the impact of this Medicare mental health coverage gap (MMHCG) on Medicare beneficiaries. Hermeneutic phenomenology was used to analyze semistructured interviews with 18 beneficiaries who had attempted to access mental health care but were limited due to the MMHCG. Three themes emerged: (a) exasperating experiences with the MMHCG, (b) the MMHCG compounds barriers to mental health care, and (c) Medicare as a flawed system. These findings suggest current Medicare mental health policy interferes with beneficiaries' access to needed mental health services. Implications for the counseling profession are described. [ABSTRACT FROM AUTHOR]

Nearly one in four Medicare beneficiaries have been diagnosed with mental health or substance use disorders, and research indicates this population responds well to mental health treatment. However, Medicare policy omits licensed mental health counselors (LMHCs) and licensed marriage and family therapists (LMFTs) as approved providers, exacerbating an existing national provider shortage. Emerging research demonstrates that the provider omission, referred to as the Medicare mental health coverage gap (MMHCG), profoundly impacts excluded providers and the communities they serve. This paper represents a synthesis of the most current scholarship on Medicare research, policy, and advocacy. In particular, we explore three ways the MMHCG impacts providers and beneficiaries alike: limiting provider choices, thwarting continuity of care, and creating challenging decisions for beneficiaries and providers. Our aim is to help mental health counselors better understand and navigate the MMHCG and aid in advocacy efforts for legislation to include LMHCs and LMFTs as approved Medicare providers. [ABSTRACT FROM AUTHOR]

Using quantitative content analysis, we categorized 76 out of 154 articles (49.35%) published in Adultspan Journal from 1999 to 2019 as focused on gerontological counseling. This study explored publication trends for these articles and compared results with a larger study (Fullen et al., 2019) on publication trends for gerontological counseling across all counseling‐related journals. [ABSTRACT FROM AUTHOR]

This study examines counseling professionals' knowledge concerning the Medicare program and related advocacy efforts. American Counseling Association members (N = 5,097) answered a series of true-false questions that were intended to measure proficiency in two areas: Medicare policy and the counseling profession's advocacy for provider eligibility. Statistical analyses indicated that members have a wide range of Medicare knowledge. A significant difference in advocacy history knowledge was found when comparing counselor educators, practicing counselors, doctoral students, and master's students. However, no differences in policy knowledge were present among these groups. Implications for the counseling profession and counselor training are discussed. [ABSTRACT FROM AUTHOR]

To better understand the impact of the Medicare mental health coverage gap, the authors analyzed survey data provided by 1,859 members of the American Counseling Association using a conventional qualitative content analysis. One overarching theme, direct impact of Medicare policy on the counseling profession, is presented, along with 3 thematic categories: emotional impact on providers, economic toll on providers, and negative influence on profession's credibility. Implications for the counseling profession are discussed. [ABSTRACT FROM AUTHOR]

The authors surveyed 6,550 members of the American Counseling Association regarding the current impact of Medicare policy on counseling professionals. More than half of respondents (54.8%) had been directly affected by Medicare reimbursement barriers, including 70.0% of practicing counselors. Statistical analyses indicated significant associations between years in the profession, direct experience with the Medicare coverage gap, and participation in professional advocacy related to Medicare. Implications for counselors, counselor educators, and counseling scholarship are discussed. [ABSTRACT FROM AUTHOR]

The authors analyzed data from 5,528 American Counseling Association members to examine advocacy beliefs and behavior regarding Medicare reimbursement and advocacy for counselors. Nearly half (49.3%) of the respondents had participated in one or more forms of Medicare reimbursement advocacy. Advocacy participation differed significantly by professional status. [ABSTRACT FROM AUTHOR]

This study illuminates the impact of existing Medicare mental health provider policy on individuals seeking counseling services. The authors applied qualitative content analysis to data provided by members of the American Counseling Association. Two superordinate themes, current Medicare policy encumbers the Medicare-insured and creates a unique hardship on specific client populations are presented in depth in this article, in addition to several emergent themes. The results suggest that current Medicare policy has far-reaching undesirable consequences for the Medicare-insured. [ABSTRACT FROM AUTHOR]

Because of demographic changes and the prioritization of Medicare reimbursement, there is greater attention to the mental health needs of older adults. To better understand the current state of gerontological counseling research, the authors completed a content analysis of counseling scholarship spanning 26 years. Only 1.68% of the articles reviewed focused on topics related to gerontological counseling. The authors analyzed publishing patterns, topics explored, and the roles of theory and empirical research in gerontological counseling research. [ABSTRACT FROM AUTHOR]

This interpretative phenomenological analysis explored licensed professional counselors' experiences of turning away Medicare beneficiaries because of the current Medicare mental health policy. Researchers used semi-structured interviews to explore the client-level barriers created by federal legislation that determines professional counselors as Medicare-ineligible providers. An in-depth presentation of one superordinate theme, ineffectual policy, along with the emergent themes confounding regulations, programmatic inconsistencies, and impediment to care, illustrates the proximal barriers Medicare beneficiaries experience when actively seeking out licensed professional counselors for mental health care. Licensed professional counselors' experiences indicate that current Medicare provider regulations interfere with mental health care accessibility and availability for Medicare-insured populations. Implications for advocacy are discussed. [ABSTRACT FROM AUTHOR]

Despite the counseling profession's widespread interest in wellness, little research has been conducted on wellness in older adulthood. The author reviews the literature to identify current trends in research on wellness among older adults. Out of 273 articles, only 40 (14.63%) used a multidimensional, holistic framework. Further analysis revealed a lack of multidimensional models that were normed on older adults or tailored to their needs. The author concludes with an 8‐dimensional wellness framework to guide future research. [ABSTRACT FROM AUTHOR]

The authors surveyed 210 adults ages 56 to 97 to better understand which variables affect perceptions of aging. A correlational design was used to determine whether wellness and resilience predicted positive age perception and internalized ageism among this group. Both variables were found to significantly predict age perception, and the data supported an interaction effect between age and resilience when predicting internalized ageism. Results may inform counselors, counselor educators, and other professionals who work with older adults. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the study was to compare the relative contributions of Rowe and Kahn’s definition of successful aging (SA), resilience, and the holistic wellness paradigm for predicting happiness, life satisfaction, and self-rated physical health in late life. Method: A cross-sectional research design was used to survey 200 residents across 12 senior housing sites. Criteria with strong psychometric properties representing the three constructs were operationalized using hierarchical regression within the context of relevant control variables to compare the relative strengths of the three paradigms for predicting measures of quality of life. Results: In this study, 8.5% of the sample met modified criteria for SA and were used as a comparison group with those who did not meet the criteria. Overall, holistic wellness and resilience predicted happiness, life satisfaction, and physical health better than SA alone. When predicting happiness and life satisfaction, race and holistic wellness were significant predictors. Age and holistic wellness were the best predictors of self-rated physical health. Conclusion: The criteria underlying SA poorly predicted happiness, life satisfaction, and self-rated physical health compared to the resilience and holistic wellness models. The results suggest that definitions of aging well are complex and require greater nuance. The findings have important implications for clinicians seeking translatable theoretical models that are amenable to practice with older adults, especially for those living in independent senior housing communities. [ABSTRACT FROM AUTHOR]

As the number of older adults increases, it is important to understand how attitudes toward aging influence society, the aging process, and the counseling profession. Ageism--defined as social stigma associated with old age or older people--has deleterious effects on older adults' physical health, psychological wellbeing, and self-perception. In spite of research indicating that the pervasiveness of ageism is growing, there are few studies, whether conceptual or empirical, related to the impact of ageism within the practice of counseling. This article includes an overview of existing literature on the prevalence and impact of ageism, systemic and practitioner-level consequences of ageism, and specific implications for the counseling profession. Discussion of how members of the counseling profession can resist ageism within the contexts of counselor education, gerontological counseling, advocacy, and future research will be addressed. [ABSTRACT FROM AUTHOR]

Resulting from the assumption that older adulthood is a time of decline, there is a dearth of research on the application of wellness counseling with older adults. This article reviews the literature on wellness and older adults, synthesizes wellness with adult development theory, and describes wellness counseling with older adults. [ABSTRACT FROM AUTHOR]

Resilience has been described as a paradigm for aging that is more inclusive than models that focus on physiological and functional abilities. We evaluated a novel program, Resilient Aging, designed to influence marginalized older adults’ perceptions of their resilience, self-efficacy, and wellness. The multiweek group program incorporated an inductive definition of resilience based on group members’ lived experiences. Outcomes evaluation for this pilot study included pre/postassessments on resilience, self-efficacy, and six wellness variables. Twenty-nine participants completed the program. Pre/post-assessment indicated a statistically significant multivariate change across the eight outcome variables. Increases in resilience, physical wellness, and emotional wellness, and decreases in social wellness and intellectual wellness accounted for most of the multivariate change. Resilient Aging is a participant-centered and strengths-based program that has potential for enhancing participants’ perceptions of resilience and wellness. The program can be administered within community settings to promote resilience and wellness among marginalized older adults. [ABSTRACT FROM AUTHOR]

Older adults are at an elevated risk for suicide. A comprehensive framework for preventing older adult suicide should include knowledge about risk factors, a theoretical basis that explains the high prevalence of older adult suicide, and a transdisciplinary prevention strategy that shares responsibility for suicide prevention among professional and lay members of the community. The author introduces a community-based suicide prevention strategy that employs health and mental health professionals, aging sector professionals, caregivers, and older adults to recognize and respond to older adults who may be in distress. [ABSTRACT FROM AUTHOR]

Medicare reimbursement for counselors would expand older adults' access to mental health services and increase counselors' professional opportunities. To enhance advocacy efforts, the author reviews Medicare's current role in meeting older adults' mental health needs, examines the program's unique political development, and identifies contemporary values that may influence Medicare's future. Implications for counselor advocacy efforts are discussed. [ABSTRACT FROM AUTHOR]

Harm reduction (HR) approaches to substance use show promising efficacy, but limited research exists exploring professional counselors' perceptions of HR. An online survey gathered data from 395 substance use providers, including 128 professional counselors. In measuring HR acceptance, t‐tests compared this sample to prior samples, an analysis of variance compared counselors to other providers, and multiple regression explored the influence of counselor identity factors. Empathic responsiveness and positive social justice attitudes were predictors of HR acceptance. Counselors' perceptions of HR were similar to other providers. Results indicated that counselor identity influences HR perceptions, with implications for practice and training considered. [ABSTRACT FROM AUTHOR]

Despite the availability, some residents choose not to participate in wellness offerings at their residential communities. Perceptions of aging can influence engagement in healthy behaviors. The purpose of this research was to examine the relationship between perceptions of aging and wellness engagement among Life Plan Community residents. A total of 447 residents (ages 59 to 97; M = 81.82, SD = 6.55) of 10 Life Plan Communities completed surveys that measured their perceptions of aging, self-reported wellness, interest in improving wellness, participation in wellness programs, and barriers to wellness participation. Multiple regression analyses revealed that more positive perceptions of aging were associated with better wellness, higher interest, more frequent participation, and fewer barriers. Follow-up analyses revealed that these effects could be accounted for by specific types of aging attitudes (i.e. psychological growth, psychosocial loss, and physical change). These findings have implications for the development, implementation, and promotion of wellness programs for older adults. [ABSTRACT FROM AUTHOR]

Older adults are at risk for mental health concerns, such as social isolation and suicide. Risk factors to suicide among older adults, such as loneliness and social isolation, may be impacted by the COVID-19 pandemic. Gatekeepers in the community are a significant source of identification and referral of older adults at risk of mental and physical health concerns. In this study, we sought to discover whether natural helpers in the Aging Service Network (ASN), including volunteers and providers (n = 93) obtain and utilize suicide-intervention skills with older adults who receive home-delivered meals (HDM) after being trained in a 14-hour evidenced based training. Paired-sample t-tests yielded significant results at pre- and post-test measures of suicide intervention response skill acquisition, and over 19% of trained participants reported using suicide intervention skills over six months. Implications for future training and research are discussed. [ABSTRACT FROM AUTHOR]

The framework of intersectionality has become a mainstay of counseling research and practice, given its theoretical underpinnings in social justice (see Chan et al., 2018; Chan & Erby, 2018; Mitchell & Butler, 2021). Using the multicultural and social justice counseling competencies to decolonize counseling practice: The important roles of theory, power, and action. When being "essential" illuminates disparities: Counseling clients affected by COVID-19. The four articles in this special issue highlight timely topics on advancing the science and practice of counseling as a developmental approach. [Extracted from the article]

To examine wellness and well‐being research in professional counseling journals, we completed a comprehensive 31‐year content analysis of counseling research within 25 counseling journals. Of the sample of 374 publications that met the search criteria, wellness publications accounted for 222 (59.4%) of the articles, and well‐being publications accounted for 152 (40.6%) of the articles. The authors examined publication patterns, topics, theoretical frameworks, and research methodologies within wellness and well‐being counseling research. [ABSTRACT FROM AUTHOR]

Telebehavioral health offers a unique opportunity to expand access to mental health services for older clients by addressing systemic barriers that often render mental health care inaccessible in later life. Although health interventions facilitated by technology, including telebehavioral health approaches, proliferated at the start of the COVID-19 pandemic, little guidance exists for counselors seeking to provide such services to clients in later life. In this manuscript, we describe barriers to accessing mental health services, how telebehavioral health services can address these barriers, and practical consideration for delivering telebehavioral health approaches for counselors who work with older clients. [ABSTRACT FROM AUTHOR]

Across the globe, COVID‐19 has disproportionately affected the physical and mental health of several vulnerable groups. In a series of two cross‐sectional studies conducted April to July 2020, we examined its acute mental health effects on two vulnerable U.S. community samples—home‐bound older adults who were at or below the poverty line (Study 1, N = 293, Mage = 76.94, SD = 8.64; 75.1% female, 67.9% Black) and adults with chronic disease (Study 2, N = 322, Mage = 62.20, SD = 12.22; 46.3% female, 28.3% racial/ethnic minorities). Based on the conservation of resources theory, we hypothesised that pandemic‐related resource loss would be associated with greater mental distress, but perceived social support and positive psychological characteristics (trait resilience and optimism) would buffer against this adverse effect. Across both samples of vulnerable adults, pandemic‐related resource loss was related to mental distress. Perceived social support was related to lower mental distress but did not consistently buffer the effect of resource loss on mental health. However, in Study 2, both trait resilience and optimism buffered this relationship. Findings are discussed in terms of their implications for the conservation of resources theory. [ABSTRACT FROM AUTHOR]

This quantitative synthesis combines results of 59 studies that published psychometrics of the Five Factor Wellness Inventory (5F‐Wel; Myers & Sweeney, 2005a, 2005b). Although few studies reported complete statistics, and demographically targeted research studies are needed, this synthesis reflects that the 5F‐Wel (also known as the FFWEL; Mind Garden, n.d.) is sound psychometrically for adults: Internal consistency, subsample means, and intrascale correlations are promising, as are correlations with related constructs. Consequently, the 5F‐Wel demonstrates utility for clinical use when working with clients on wellness goals. [ABSTRACT FROM AUTHOR]