Search

Asian Americans represent a growing population of clients seeking professional assistance for a variety of social and emotional difficulties. Asian American clients often have a collective notion of “self” because they are highly influenced by family and culture. Consequently, crisis work with Asian American clients requires very different treatment strategies than those used in work with western clients whose notion of “self” is far more individualistic. The cultural issues at play in the development of a “Collective Self are described in the article and five common crisis situations are given with case illustrations suggesting effective treatment strategies.

This chapter examines how organizations, businesses, workers, and victims can enhance the prevention and treatment of sexual harassment in the workplace. We begin by describing the background, scope, and severity of the sexual harassment problem. Secondly, we present some employer-related issues regarding sexual harassment in the workplace during the economic downturn. Finally, we suggest policies and approaches for the establishment and implementation of more-positive sexual harassment policy and treatment.

One of the more common workplace problems in America today is that of workaholic behavior. As the chapter notes, hardworking individuals should not be confused with workaholics, and neither should people be thought of as workaholic if their jobs are demanding and require a great deal of time spent on work. Workaholics are those individuals who work hard for reasons that are dysfunctional and often include using work to fill in lonely time rather than dealing with loneliness, perfectionism, fear of failing, and a host of other problems that are better dealt with in counseling than through long, often unproductive hours spent on work. Ten types of workaholics are noted in the chapter. Irrational ideas that often lead to workaholic behavior are also provided along with several types of counseling that have potential to reduce workaholic behavior. Several case studies are provided that demonstrate how specific types of counseling can help change workaholic behavior.

In this chapter on competency-based evaluations special attention is paid to understanding the need for objective, measurable work objectives that are at the same time realistic, relevant, and ethical. Discussion includes merit systems and ways to set them up in a human service agency. You are asked to consider how you might work with a member of your team whom you supervise who, while a wonderful person with concern for others and loyalty to the agency, at the same time isn’t very effective.

Workers and families have been impacted by significant work-related changes, including mass layoffs and involuntary job displacement through shutdowns. Better planning and working alliances are needed to assist displaced workers from diverse backgrounds to adapt to job loss and thereby reduce the disproportionate stress in those families. While these policies have helped displaced workers adjust to involuntary joblessness, there is still a need for social support that helps minimize the damage to them. Workers and families can be more dramatically impacted when single-parent families have become jobless and are dependent on government assistance. It is also in the best interest of the whole society that businesses, organizations, and the government form collaborations and alliances that address the long-term needs and well-being of displaced workers.

This chapter discusses the basic characteristics of competency-based management (CBM) and how it differs from unsupported use of managerial wisdom. It also provides arguments for and against the use of best evidence and notes that the positive arguments outweigh the negatives. Nonetheless, there are some concerns about the use of best evidence in management. These include the lack of well-done studies showing that competency-based management is superior to less research-oriented approaches and the resistance of managers to use research findings as a management tool. Managers often make the argument that every work situation is different and generalizing from studies to a specific workplace or a specific worker will lead to serious mistakes. A case example is provided to show how managers can use CBM in their own practice with common managerial problems that, left unresolved, may morph into serious problems for workers, individually and collectively.

This introductory chapter spells out the many and varied problems in the current workplace and confirms that worker dissatisfaction is at an all-time high. Reasons for worker unhappiness are related to the poor economy and the increase in stress as fewer workers take on much more of the workload. Beyond the demand for workers to work harder and to take on more assignments is the increasing awareness that some employers are taking advantage of workers and not compensating them fairly. This is borne out in data showing that workers are often asked to work extra hours off the clock and that there has been a substantial increase in the number of law suits alleging that workers have not been paid for work exceeding 40 hours. The chapter also points out that American workers are paid as much as $20 or more per hour less in salaries and benefits than is the norm for European companies. Many organizations blame unions for the loss of industrial jobs and unfair demands made in labor negotiations, but as one high-level executive told us, unions and management are now working cooperatively to improve production and save jobs. Keeping jobs in the U.S. that are vital to our national survival is something that will keep American jobs at home and bolster an economy in the doldrums.

This chapter defines three types of work-related problems that impact a worker’s performance: job stress, job dissatisfaction, and worker burnout. It is suggested that the three move in tandem with one another, with job stress leading to job dissatisfaction, and dissatisfaction, unless corrected, leading to burnout. Many researchers believe that burnout is a type of depression that saps motivation to work. All three conditions impact work effectiveness and often intrude into the personal lives of workers. Instruments to measure stress, dissatisfaction, and burnout are provided, but in the case of burnout a simple question asking workers if they are depressed can have the same impact as the use of a burnout instrument. Supervisors observing worker attitudes and performance can often identify all three conditions on the basis of simple behaviors such as tardiness, missing work with vague reasons, minor illness, decline in the quality and quantity of work, and a thorough lack of enthusiasm. Early research suggesting that unhappy workers had the same level of productivity as happy ones have been thoroughly debunked in later research showing that job unhappiness not only affects productivity but may have a negative impact on health, mental health, and personal and family lives. Several workers gave their personal descriptions of how it feels to have each of the three work-related conditions discussed in the chapter.

The recent economic downturn has had a direct impact on diversity in the workplace. It is obvious that the issue is too complex for a simplistic effort to be capable of addressing all of the factors related to diversity in the workplace. A diverse workforce is a direct reflection of a rapidly changing society and economy. Respecting and promoting individual differences brings great benefit to organizations. A diverse workplace can benefit both the employee and the employer. It has been demonstrated that a diverse workplace will create a competitive edge and increased work productivity. Positive diversity management benefits employees by creating a fair and non-discriminatory environment where everyone has access to opportunities and challenges. Organizations with a diverse workforce must use effective management tools to educate employees and managers concerning the value of diversity. This will include fairness based upon laws, policies, and regulations.

In this chapter on treatment, three types of work-related problems frequently seen in Employee Assistance Programs and by other mental health professionals working with job unhappiness and anxiety, burnout, and substance abuse are discussed. Evidence-based practice (EBP) and substance abuse research findings are reported that suggest the effectiveness of very brief treatment with high-risk workers. Promising research on natural recovery and self-help groups suggests that treatment effectiveness may be consistently positive with these two approaches. Research issues related to effective substance abuse treatment are provided and suggestions are given to help improve research designs. A case study is provided that demonstrates the use of EBP with substance-abusing clients.

This chapter on hiring, in-service training, and termination presents practical information on the importance of correct ways of hiring and terminating workers for cause. Because of the bad economy where employers have used lack of funding in an organization to terminate workers, it’s wise to remember that workers have rights and that, even if funding isn’t as available as it has been in the past, termination must be done in a way that can be justified if a worker files a grievance or law suit. Up to 200,000 workers each year are terminated and have had their legal rights violated. Similarly, hiring can be an arduous process if it is done badly; practical information from the literature is provided to make hiring as scientific and accurate as it can ever be, realizing that there are limits even in the best hiring process. An example of a termination meeting with a worker is provided along with a case study of a badly functioning work unit with examples of how the manager is able to deal effectively with the many problems in her unit. Material is also presented on the importance of in-service training, and reference is made to Chapter 10 which shows how behavioral worker evaluations are done and how they afford organizations more protection from law suits and grievances if workers don’t meet standards and are terminated for cause.

This chapter discusses teamwork and other cooperative efforts and whether teams provide the benefits we often think they do. Ways of organizing teams are discussed and impediments to effective teamwork are identified. Fault lines are the problems that sometimes occur among a diverse workforce where culture, gender, race and ethnicity may actually inhibit the team from coming together and working effectively. The material presented isn’t meant to discourage diversity but to make the reader aware of some of the underlying problems that exist in a culturally and ethnically diverse workforce and to resolve issues as they arise to prevent the team from failing. A case is provided showing what happens when professionals are unable to work together as a team. By way of a case study, the reader is asked to consider the problem of non-professional staff members failing to provide coverage when a staff member was absent, its impact on provision of services, and the possible cause.

Quality of Life (QoL) is a dynamic concept that is determined by a range of interacting objective and subjective measures. The degree to which an individual’s desires and ambitions are met often depends upon their perception of the position they hold in the context of their culture. In relation to job-displaced workers the concept of QoL is an appropriate method to measure an individual’s goals and personal concerns. Both generic and specific appraisals can be made with QoL of an individual’s circumstances and attitudes measured against an ideal standard. QoL measures provide a useful means of assessing the feelings, goals, and quality of life of displaced workers in the context of the recent economic downturn. Quality of Life Therapy can provide a useful multidisciplinary approach to assess a wide range of individual domains that constitute a person’s quality of life. QoL measures can be applied as both generic and specific measures depending on whether the purpose is for assessment, treatment, or evaluation of a job-displaced worker’s quality of life.

Quality of Life Therapy (QOLT) is presented as an appropriate and useful method of addressing some of the consequences of the recent economic downturn on the lives of working people. The domains or areas of life and settings that are impacted are appropriate and important for the application of QOLT. While addressing the issues that affect job-displaced workers, QOLT is a coping resource that boosts personal, social, and emotional attributes that a person can utilize to offset the negative financial impact of involuntary unemployment.

This chapter discusses the issue of early diagnosis of violent behavior in children. It is important to note that although there is evidence that early onset of violent behavior in children is associated with adolescent and adult violence, the chapter, after all, discusses children whose behavior is not completely formed. Many factors contribute to the continuation or discontinuation of violent behavior in young children. One of the strongest reasons for discontinuance of violent behavior is early intervention. Further, while profiling children for early signs of violence may lead to needed treatment, one should be cautious about using indications of violent behavior to project into the future. Many things change in a child's life and the benefits of positive influences, including helping professionals, teachers, mentors, religious affiliations, parents, siblings and extended family, should not be discounted. Children with early signs of violent behavior should not be categorized, but an evaluation should be made to find out why the violent behavior is beginning to show itself so early in life. There are many reasons for early violent behavior. Violent behavior is often a reflection of early childhood physical and sexual abuse and neglect. Early violence may be associated with parental drug and alcohol abuse, learning difficulties, poor peer relationships, and a host of treatable conditions. The chapter discusses the two most commonly used diagnoses predicting anti-social and violent behavior: oppositional defiant disorder and conduct disorder.

The abuse and neglect of older adults is a very serious and growing problem. This chapter discusses the frequency of abuse, caretakers who abuse elders, and treatment interventions with caretakers and victims. The lack of research data on interventions with abused elders is noted and suggestions are given as to how points of view about aging need to change to prompt more research. A case study applying evidence-based practice (EBP) is provided in the chapter with a discussion of a case by a worker. Legal definitions of elder abuse are also given, as well as research questions that need to be answered for the human services to reduce the frequency of abuse. Community and policy interventions are also provided.

Large numbers of depressed older adults often go undiagnosed and untreated because symptoms of depression are often thought to be physical in nature and professionals frequently believe that older adults are neither motivated for therapy nor find it an appropriate treatment. This often leaves many older adults trying to cope with serious depressions without adequate help. This chapter on evidence-based practice (EBP) with depressed older clients points out the frequency and severity of depression in older adults and the high rate of completion of suicide, particularly in aging men. The chapter also notes the efficacy of treatment with older depressed clients and shows how single subject research with goal attainment scaling can be a simple and effective way of evaluating treatment progress. Two case studies show the cause of depression in two older adult clients and the way EBP approaches the best evidence for use in treatment decisions.

Aging is thought of as a time of increased loneliness and isolation. Spouses have sometimes passed away or become too frail to offer companionship, and adult children are involved in their own lives and do not have time to be with parents. It is not uncommon in society for older adults to have a limited role, and aging brings with it the isolation of not having family or family nearby. Illness often prompts an additional sense of isolation and aloneness, and romance and intimacy are sometimes increasingly limited. This chapter about loneliness provides reasons for social isolation that sometimes leads to depression in older adults. Internal and external reasons for loneliness are explored and a case is presented of a lonely older man and the evidence-based practice (EBP) treatment he receives for loneliness and why it seems to be helping him. A personal story explores the complicated relationship of a mother and daughter whose relationship is causing the mother to feel lonely and isolated from her family.

This chapter covers some important issues related to the therapeutic relationship and its significance to treatment effectiveness. While some of the authors cited in the chapter believe that the relationship is a key element in treatment effectiveness, many also believe that much more research is needed to establish the specific aspects of the relationship that help or hinder client change. Issues of the significance of client worker gender and race\ethnicity are also raised, with many authors believing that both issues have an impact on treatment efficacy and that much more time must be spent in training new workers for effective work with diverse client populations. A case study is included in the chapter that describes a cooperative worker–client relationship.

This chapter discusses the resilience of gay, lesbian, bi-sexual and transgender children and adolescents. Three stories discuss difficult issues facing GLBT individuals including homophobia, coming out about their sexual orientation, and family rejection. Homophobia is a serious problem resulting in gay bashing, depression, and higher levels of suicide among GLBT individuals. Clearly, much of the difficulty faced by GLBT individuals can be explained by external pressures and attitudes that are sometimes internalized by GLBT clients and may challenge new ways of coping with issues related to their gender identity. A more accepting and understanding society would go a long way toward reducing psychosocial problems experienced by GLBT children and adolescents in America.

This chapter discusses the staggering numbers of abused children in United States, the causes of abuse, and best evidence for the assessment and treatment of abused children. The chapter notes that even abused resilient children who do well on many behaviorally oriented measures sometimes suffer negative emotional consequences including depression and low self-esteem. Concern is raised for the limited amount of knowledge at present on effective treatment approaches for abused and neglected children. A case study describes treatment with a severely abused child.

This chapter discusses the difficulty of making correct and accurate diagnoses for emotional problems with older adults, and the many clinician biases that may result in incorrect diagnosis. An example of a psychosocial assessment that focuses on client strength is provided. Used correctly, a psychosocial assessment can provide the practitioner with an understanding of the connecting elements that have created the current crisis in a client's life. It can also help clinicians develop strategies that may move the older client in positive ways. A key to the use of the psychosocial assessment is to recognize positive client behaviors and to support assumptions about the cause of a problem and the most efficacious treatment with recognition of the best evidence available from the research literature.

Estimates of loneliness among children and adolescents suggest that loneliness is a serious, often unrecognized problem. According to Asher et al., more than 10% of children in grades three through six report feelings of loneliness defined in part by not having anyone to play with. Moore and Schultz estimate that loneliness among high school students ranges from 8% to 16% of all students. In surveys of school counselors and social workers, Calabrese and France et al. report an increasing proportion of young people who feel alienated, isolated and alone as a result of increasing mobility, rising divorce rates, increasing numbers of single-parent families, and declining access to the extended family. Additional factors that may contribute to feelings of loneliness in children include: death of a parent or a significant person; divorce of parents; conflict within the home or at school; child abuse and neglect; moving to a new school or neighborhood; losing a friend, possession, or pet; immigrant status coupled with limited competence in English; poor clothing and hygiene; concerns about physical attractiveness; and routine rejection by playmates. Low self-esteem, shyness, anxiety, and self-consciousness, aggressiveness, and higher sensitivity to rejection may also contribute to inadequate peer relationships and difficulty in making friends. This chapter provides reasons for social isolation that sometimes leads to depression over the course of the life span. Internal and external reasons for loneliness are explored and a case is presented of a lonely adolescent boy and the EBP treatment he receives for loneliness, and why it seems to be helping him.

Publisher Summary A considerable amount of literature in the past few years suggests that successful aging is the absence of physical and emotional disabilities, but new research suggests that perceptions of older adults about the aging process are more important than the influence of illness and physical disability and depend on attitude, resilience, optimism, and coping style. When those issues are taken into consideration, an older person can often control successful aging. This chapter explores the various studies suggesting a wide range of definitions of successful aging. The chapter discusses the notion of successful aging and the psychosocial factors that contribute to successful aging. Impacting successful aging are indications of resilience and the ability to cope well with life stressors. Considerable research suggests that more people are resilient in the midst of crises and at-risk life conditions than had previously been thought. The chapter ends with a personal story about successful aging.

The diagnosis of Alzheimer's disease (AD) or dementia is understandably distressing. The multiple losses associated with AD and the long-term burden of care giving present challenges to individuals, families, and communities. As the population ages, the numbers of persons with AD is expected to reach epidemic proportions. Costs associated with care and the need for medical resources to manage this disease are likely to become a major social problem. Finding ways to accurately diagnose AD, and effective strategies for prevention and treatment of this terminal illness, require significant research efforts. AD is characterized by problems with memory, associated personality changes, and a gradual loss of brain functioning due to build up of plaque and tangles within the brain. Persons with AD may initially notice short-term memory problems and other cognitive changes, progressing to an inability to recognize family or friends. The multiple losses associated with AD are challenging to caregivers.

This chapter explores two important issues in aging: love and intimacy, and the practice issues that pertain to both. Data are provided showing that many older adults maintain robust sexual lives. Physical and emotional issues that may interfere with love and intimacy are provided with a case study exploring an older couple whose love life has become troublesome with a treatment intervention and a personal story of older love. Although physical changes may affect some aspects of sex, these changes give people reasons to try new positions and techniques and, in general, to experiment with new aspects of sexuality, which both partners find acceptable. The changes women experience are most often linked to menopause and reduced estrogen levels. As women age, it may take longer for the vagina to swell and lubricate when sexually aroused. A woman's vagina may also lose elasticity. Together these two conditions can make intercourse less comfortable or even painful.

This chapter reports research findings that suggest the disagreement regarding effectiveness of certain types of treatment, particularly very brief treatment with high-risk abusers. However, promising research on natural recovery and self-help groups suggests that treatment effectiveness may be consistently positive with these two approaches. Research issues are discussed that make the development of best evidence on the efficacy of all forms of treatment of substance abuse questionable, and the suggestion is made that before one can develop the best evidence, more effective studies must take place that include adequate research designs and controls. A case study is provided that demonstrates the use of evidence-based practice (EBP) with substance-abusing older adult clients.

This chapter focuses on resilience and discusses the many factors that define resilience. The chapter gives definitions of the term resilience and the attributes of resilient people. It also discusses the relationship between coping with stress and resilience. A discussion of resilience by youth in crisis provides a way of understanding how resilient youth who are traumatized understand their unique ways of coping with life stressors. A consistent finding over the last 20 years of resilience research is that most children from highly dysfunctional families or very poor communities do well as adults. This finding applies to almost all populations of children found to be at risk for later life problems, including children who experience divorce; children who live with step-parents; children who have lost a sibling; children who have attention deficit disorder or suffer from developmental delays; and children who become delinquent or run away. Coping with stress has been thought to be a dimension of resilience, although there is disagreement in the literature about the definition of coping. Some researchers see coping as a dynamic process but measure its existence by considering a person's disposition or by viewing it as something triggered by a life situation.

School violence is a serious American problem plaguing school systems all over the country. The increase in rates of violence and the fact that many victims of school violence may become perpetrators should give us pause as we consider the many intelligent children who are treated badly by lower functioning classmates, and who consider acts of violence as methods of payback for the humiliation they have suffered. An FBI profile is presented giving a number of characteristics of violence-prone youth in school, but several writers advanced the notion that children who have been bullied and harassed by school mates may form a core of “invisible children” who outwardly seem non-violent but inwardly harbor strong feelings of anger which sometimes lead to violence.

This chapter focuses on serious emotional problems of childhood and adolescence including borderline personality disorder, which often has its origins in childhood, child and adolescent schizophrenia, and because of its serious nature and its relationship to high suicide and co-occurring disorders such as substance abuse, bi-polar disorder. Before discussing borderline personality disorder (BPD), the chapter briefly summarizes the larger category of personality disorders, since BPD is part of the family of personality disorders. One of the most difficult problems facing clinicians is the treatment of clients diagnosed with a personality disorder. In the popular mind, personality disorders suggest major treatment problems. Establishing the number of people with severe personality disorders in the population is difficult because of the diversity of diagnostic criteria used. Drake and Vaillant estimate the prevalence in the population as one percent with borderline personality disorders, and a lifetime risk of antisocial personality disorder of just under three percent, with a fourfold increase in risk among men.

This chapter discusses pervasive developmental problems with special attention to autism and Asperger's syndrome and the significant but unexplained increases in pervasive developmental disorders (PDD). The chapter suggests that Asperger's syndrome is really high-level autism. Treatment options are summarized and a case of misdiagnosis is provided demonstrating that many conditions, normal and more serious, explain social awkwardness and many of the symptoms of Asperger's syndrome. Careful attention to the diagnostic indicators of PDD is recommended before a diagnosis is given. The term pervasive developmental disorders was first used in the 1980s to describe a class of disorders that have the following characteristics in common: Severe and pervasive impairments in social interaction, imaginative activity and verbal and nonverbal communication skills; and a limited number of interests and activities that tend to be repetitive. Five disorders are identified under the category of pervasive developmental disorders: (1) autistic disorder, (2) Rett's disorder, (3) childhood disintegrative disorder, (4) Asperger's syndrome, and (5) pervasive developmental disorder-not otherwise specified, or PDD-NOS. The two most common PDDs, autism and Asperger syndrome, are discussed in detail. Two less common PDSs and the category of PPD-not otherwise specified are also briefly discussed.

This chapter discusses the changing American family and the many pressures and stressors placed on family life. Although great progress has been made, too many children are still without adequate medical care, housing, finances or nutrition. A story noting problems in a family describes the impact of a child who is scapegoated by his siblings and parents. Family life has been changing in America for better and for worse. Divorce rates, while declining, are still very high. Too many families lack medical insurance or suitable housing. Far too many children suffer from lack of food or abusive conditions and, more than ever, families are held to very high legal standards in terms of their ability to care for children. Yet families are the system that should socialize children and teach them ethics and values. Families are supposed to house and feed children and care for them when they suffer from physical and emotional problems. And families are also supposed to promote education and teach children about citizenship and love of country and community. But when they can't or don’t, there is a complex social service system to offer financial, housing and counseling services often staffed by social workers. This safety net of services is in place to help families stay together and function well. The chapter explores the nature of those services and the way social work functions in the social welfare agencies and organizations most responsible for helping families in need.

This chapter considers depression, diagnostic factors, risk factors for depression and treatment approaches, with attention paid to prevent and recurrence after treatment. The chapter also includes a case study of a child receiving a treatment suggesting best evidence. Depression is often associated with thoughts of suicide. Suicidal ideation refers to any self-reported thoughts of engaging in suicide-related behavior. Some investigators also consider thoughts that are less explicit in terms of wanting to take one's life (wanting to be dead, not wanting to awake) as indications of “passive” suicide ideation. While suicidal ideation may not lead to actual suicidal attempts, they are considered serious risk factors since there are an estimated 8–25 attempted suicides for every completion and suicidal ideations may move to suicidal attempts given situational conditions that may be hard for the clinician, or the family, to predict.

Publisher Summary Recent findings suggest that generalized anxiety is a more common problem among the elderly than depression. Anxiety and depression among older adults frequently coexist with common physical manifestations including chest pains, heart palpitations, night sweats, shortness of breath, essential hypertension, headaches, and generalized pain. Because physicians often fail to diagnose underlying symptoms of anxiety and depression in elderly patients, the emotional component of the symptoms are frequently not dealt with. This chapter discusses the serious problem of anxiety in older adults. Diagnostic suggestions are made to distinguish anxiety brought on by both physical and social causes. A case study using case management and a personal story explore older adult anxiety and the very real pain it causes in older adults. Anxiety affects 7.3% of an elderly population as compared to 2% for depression in the same population.

This chapter discusses spoiled children and cyber-bullies, a new form of bullying that uses the Internet to harass others. The chapter notes that in both cases, parents often do a limited job of preparing their children for life and either opt out of parenting by ignoring their children or give in to every whim without a sense of proper moral behavior. Parents also tend to not encourage their children's ability to exist in a society in which people must earn the right to be thought highly of through hard work and persistence. Many of the children who bully and use the Internet to mask their identities are children who feel detached from the harm cyber-bullying causes, and do not think of it as much more than a social contrivance which most people do. Many have themselves been victims. Both issues need prompt attention from parents, school personnel and therapists because spoiled children and cyber-bullies perform badly as adults without changes in parenting and treatment from knowledgeable professionals.

Publisher Summary Anxiety is a substantial problem for children and adolescents. The combined prevalence of anxiety disorders is higher than that of virtually all other mental disorders of childhood and adolescence. The 1-year prevalence of anxiety disorders in children ages 9–17 is 13%. Kashani and Orvaschel found an 8.7% rate of one or more anxiety disorder among adolescents, making it one of the most prevalent emotional disorders among children and adolescents. Kendall et al. believe that anxiety may continue into adulthood, causing significant impairment if left untreated. The Brown University Psychopharmacology Update (2007, January) reports that anxiety affects physical health and that a clear relationship exists between anxiety in children and adolescents and at least one and often multiple somatic complaints, usually restlessness, stomachaches and palpitations. Complicating the assessment and treatment of childhood anxiety is research suggesting that parents and children often disagree on the existence of the problem and its severity. This chapter discusses common child and adolescent anxiety problems, including separation anxiety disorder, generalized anxiety disorder, social phobia, and obsessive compulsive disorder, as well as the more effective treatment approaches from the research literature.

Hospice provides a team of skilled professionals working together to provide palliative care for terminally ill patients facing life-threatening illness. While under hospice care, terminally ill patients and their caregivers receive medical attention, counseling, bereavement services, volunteer help, symptom management, grief counseling, and supportive services. This chapter discusses end of life issues including the use of hospice in the late stages of a terminal illness and evidence-based practice (EBP) with bereavement and prolonged grief. The chapter also discusses the rules that apply to the use of Medicare-sponsored hospice programs and why hospice isn't used more. The most significant reasons for the under utilization of hospice appears to be concerns about dying alone and lack of referrals to hospice by physicians. A case study identifies the use of EBP with an older adult woman experiencing prolonged grief over the death of her husband.

This chapter discusses the definitions of evidence-based practice and some of the criticisms of the approach found in the literature. Among the strongest criticism of evidence-based practice (EBP) is that there is not well-defined literature at present and what is there is difficult to read and comprehend, and too time-consuming for most practitioners. There is evidence that clinicians do not use manuals that contain the best evidence. On the positive side, there is a need to organize the best practices and to assure clients and third party providers that what one does actually works. EBP is an approach that tries to organize a way of providing the best possible service to clients using a knowledge-guided approach to practice and substantial involvement of clients in decision making to assure that the client–worker relationship is cooperative. The chapter ends with a personal story about aging.

The numbers of older adults dealing with anxiety and depression are considerable and growing as the numbers of older adults increase in the USA. Health problems, loss of loved ones, financial insecurities, lack of a support group, a growing sense of isolation, and a lack of self worth are common problems among the elderly that lead to serious symptoms of anxiety and depression, problems that often coexist among many older adults. A case study presented in this chapter provides added information about the cause and treatment of depression and anxiety in the elderly. The chapter discusses the growing number of older adults and the psychosocial needs that are likely to occur as the population of elder adults dramatically increases over the next several decades. The chapter notes the importance of using the best evidence when working with older adults and the social, emotional, and health-related problems that are currently prevalent among older adults and are likely to increase in coming years.

Publisher Summary Many older men and women would like to continue working in old age, but at jobs that utilize talents and dreams and which are different than the jobs they’ve held much of their lives. For many older adults, work after retirement is not a choice but a necessity caused by limited income after retirement. Data are provided showing that older adults do better if they work or volunteer in measures of physical and emotional health. A case study and a personal study explore some of the complicating factors, positive and negative, related to work for older adults.

At a time when increasing numbers of children are being diagnosed and treated for emotional problems, the unsettling thought of misdiagnosing children who need help but are not being served because of racial and gender issues, and treatment of large numbers of children who are, in reality, responding in normal ways to maturational and social changes has begun to capture a great deal of attention in the popular and professional literature. Unlike most adults, young children are often unable or unwilling to talk about their symptoms, leaving mental health professionals to rely on observation and information from parents and teachers, which may be incorrect or biased. This chapter discusses the debate among clinicians regarding the actual numbers of youth with accurate diagnoses of emotional problems. The chapter also discusses concerns in the literature with the use of unproven psychotropic medications with very young children, their possible side effects and the lack of research evidence that medication is a better treatment than a variety of psychosocial interventions. The chapter ends with a case study showing the difficulty inherent in diagnosing youth whose behavior is still developing.

This chapter offers some hopeful evidence that self help may provide assistance to a variety of clients experiencing problems with addictions, health, mental health, and other social and emotional problems. A large number of Americans use self help, but questions remain about the validity of findings indicating that self help may be an effective alternative to professional assistance. Most of these questions relate to research issues that may be difficult to resolve given the fact that self-help groups do not have the same expectations as professional help to prove effectiveness. Self help is generally supportive in nature and usually provides an affirming and positive approach to problem solving. Some concern is raised that self-help groups may not be effective for everyone because they often have an unacceptable religious ideology and sometimes encourage people to believe that recovery is a life-long struggle. Still, the weight of findings provides a reason for optimism until empirically based research with strong methodologies provides more compelling evidence of effectiveness.

We live in a time of easy fixes to complicated problems in which medications are the answer to most health problems and talking therapy is considered a luxury, or perhaps even irrelevant. This approach has put practitioners into quite a quandary when it comes to working with children. Not only have they begun using medications with little evidence of their efficacy, but they use adult diagnostic categories to fit the medications with very young children. It is heartbreaking to think of a 3- or 4-year-old diagnosed with bi-polar disorder or chronic depression, or even worse, childhood schizophrenia, simply because a clinician or physician knows so little about children that he or she immediately thinks of an adult diagnosis and the adult medications for unformed and developing children whose childhoods will now be changed for, perhaps, a lifetime. To add to this tragedy, there is little evidence that adult medications actually work with children, and growing evidence that they often do harm.

There are many policy implications for successful aging, which one must mention because they impact successful aging. Clearly, with Americans' increasing lifespan coupled with economic problems and the need to work longer, many older adults face a very different life after 65 than previous generations of older Americans who were financially able to retire early. This chapter highlights some of the issues that appear likely to affect ageing in the future. One worries that, for many older adults, the thrill of not working will be replaced by growing boredom and lethargy, and that anxiety about health issues will dominate their lives. The growing numbers of retirement communities that are detached from the larger community add to this concern. It is also a worry that older adults will be forced to work well beyond a point of burnout because the economic safety nets in savings, pension plans, and social security are quickly disappearing, and that the ability to gradually cycle off full-time work will be replaced by work well beyond the point of being physically and emotionally exhausted.