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BOOK REVIEW |
Assistant Professor School of Social Work Georgia State University P.O. Box 3995 Atlanta, GA 30302-3995
Days in the Lives of Social Workers, edited by Linda May Grobman and Dara Bergel Bourassa. White Hat Communications, Harrisburg, PA, 2007, 313 pp., $19.95 (paper).
Gerontological Supervision: A Social Work Perspective in Case Management and Direct Care (2nd Ed.), by Ann Burack-Weiss and Frances Coyle Brennan. Haworth, New York, 2008, 166 pp., $140.00 (cloth), $39.95 (paper).
Social Work Practice with Ethnically and Racially Diverse Nursing Home Residents and Their Families, edited by Patricia J. Kolb. Columbia University Press, New York, 2007, 259 pp., $72.00 (cloth), $25.50 (paper).
The ecological perspective argues that individuals can only be understood within the context of the systems and the environment where they live (Germain, 1991). A system is a set of elements or conditions that influence one another through their interactions. An individual's social system is comprised of the people and systems that influence their development such as family, school, neighborhood, and work. This perspective guides the social work approach to practice and emphasizes the interaction between individuals, families, organizations, communities, and institutions. The ecological perspective requires a balance between client and provider-driven priorities within a social service delivery system in order to work with older adults and their families. Client-driven priorities focus on building rapport with clients, assessment, and developing and implementing intervention plans, while provider-focused priorities emphasize resource development and management, professional supervision, developing collaborative partnerships, and advocacy. It is impossible to work with older adults effectively if these priorities are not congruent and social workers are not prepared to work within and across systems.
The social work profession is a significant service provider for older adults and their families. In 2006, the Center for Workforce Studies at the National Association of Social Workers (NASW) conducted a national survey of 10,000 licensed clinical social workers in the United States. The authors found that 75% of social workers have older adults (55 years and older) in their caseloads (Whitaker, Weismiller, & Clark, 2006). As the nation's population of older adults continues to grow, we must recruit and train more gerontological social workers. Social workers interact with active, healthy older adults as well as those who are ill in settings that range from adult day care centers and nursing homes to community mental health centers. Social workers provide an important link between seniors and the services designed to help them by assisting older adults and their families make decisions on assisted-living arrangements, caregiver support, and long-term care. Although direct service provision is the most commonly used role with older adults, social work professionals are engaged in administration and management, consultation, training and education, policy, and research.
As more social workers specialize in practice with older adults and their families, the profession must expand its knowledge base and produce competent, skilled professionals to work with this diverse segment of the U.S. population. This essay will comment on three related books that focus on gerontological social work practice and supervision. These books represent the broad scope of the social work profession and the opportunities and challenges associated with gerontological social work practice and supervision in an increasingly diverse society. A consistent theme is the importance of developing and retaining competent social work professionals to work within the field of gerontology. These books are useful for both new and "seasoned" social workers because each author has articulated how client- and provider-driven issues related to cultural competence, ethical practice, and quality supervision can contribute to improved service delivery for older adults. The insights drawn from their experiences and historical analysis can contribute to the profession's knowledge base and practice models that focus on gerontological social work.
Ann Burack-Weiss and Frances Coyle Brennan provide a practical "how-to" guide for social work supervisors, which uses a person-in-environment approach to illustrate strategies for working with direct care social workers as they develop and implement intervention plans. Grobman and Bourassa's book is a collection of 44 personal narratives from social workers about their experiences and insights learned from working with older adults in practice settings such as the community, health care, and nursing homes. Nontraditional settings and methods such as art therapy and psychoeducational support groups in a business environment are featured as well as policy and macro practice. Consistent with the demand for culturally competent practice, Patricia J. Kolb provides an overview of the salient historical, cultural, and practical considerations when working with African American, American Indian, Chinese American, Italian American, Japanese American, Korean American, Mexican American, and Puerto Rican older adults. When taken together, these three books represent the broad spectrum of gerontological social work practice, yet they provide a framework and guide for culturally competent practice and supervision from an ecological perspective.
A Day in the Life
Grobman and Bourassa have assembled an inspiring collection of narratives that provide insight into the multiple roles and tasks associated with gerontological social work. Part one describes the experiences of social workers who are employed in community-based settings such as adult protective services, naturally occurring retirement communities, geriatric community care management, and a community senior center that works with older immigrants. Part two explores social work within health-care settings such as a VA hospital, home health, hospice, the emergency room, and an outpatient rehabilitation facility. Nursing home settings are the focus of part three and present the perspectives of an administrator, an ombudsman, and a nursing home surveyor. Instead of addressing practice settings, part four examines specific issues and subpopulations: acute mental health, Alzheimer's, Parkinson's disease, substance abuse, and homelessness. The final essays represent nontraditional methods and settings such as art therapy, integrative touch, and social work practice in law and business. For example, an essay on community organizing and another on lesbian, gay, bisexual, and transgender aging are the entries in the policy and macro practice section (part five). The final section is devoted to the perspectives of social work undergraduate and graduate students, educators, and researchers, and includes an essay by a social work educator who shares the lessons she has learned about aging from centenarians in India.
The book is most appropriate for professionals new to gerontology and/or students who are exploring career options. Instead of focusing exclusively on the constraints and barriers to service delivery, Grobman and Bourassa have selected essays that also represent the rewards associated with gerontological social work. The essays provide a first-person account of the typical roles and responsibilities they assume on a regular basis. They are rich in their descriptions of the opportunities, strengths, and lessons learned from their encounters with individuals, groups, and institutions that influence their practice methods. At the conclusion of each chapter, a "Think about it" section is included to provide the reader an opportunity to critically analyze practice issues relevant to the essay. For most of the essays, the quest for ethical and competent practice is a central theme as the social workers describe their experiences. These essays provide examples of the strategies and skills social workers use to work with older adults and their families as they navigate multiple systems and bureaucracies. After reading the essays, readers will have an understanding of how gerontological social workers manage client and provider priorities simultaneously.
Pursuit of Culturally Competent Practice
As individuals transition into late adulthood, their current state of functioning is a culmination of their life experiences. Thus, it is important for gerontologists to understand the cultural context of behavior among older adults. From a systems perspective, a person's culture will affect their worldview and influence their perceptions of and interactions with social workers and other professionals. From a client perspective, interaction with a social worker who not only is culturally sensitive but also competent is more likely to be positive once trust is established. Thus, it is important for the social worker to view the older adult holistically and within the context of their culture throughout the professional relationship. For program administrators and managers, cultural competence must be incorporated into the organization's operating procedures and addressed during supervision to create an environment that is mindful of the diversity within its client population. Although most professionals would agree that cultural competence is important, it can be a challenge to develop a broad understanding of the cultural nuances of specific ethnic/racial groups with practical strategies that facilitate culturally competent practice.
In an effort to fill a gap in the literature on culturally competent practice, Kolb and her colleagues provide an excellent overview of the cultural attributes that influence the life experiences of nursing home residents and their families. As Kolb notes in her introduction, about 12% of the U.S. population is age 65 years and older. Within this segment of the population, 12% identified themselves as African American; 1% as American Indian and Alaska Native; 4% as Asian; 14% as Hispanic/Latino; less than 0.5% as Native Hawaiian and other Pacific Islander; and 67% as white non-Hispanic. According to the NASW study, "The elderly in America will be more diverse in the future than they are today. The population of aging Hispanics, African Americans, and Asian Americans is expected to grow faster than that of urban whites. This suggests the services will need to reflect the diversity of those served and that professionals will need to respond to the cultural background of future clients" (Whitaker, Weismiller, & Clark, 2006, p. 12). Although the book focuses on nursing home residents and their families, the content can be applied in other settings. The book's nine chapters include such topics as family and community roles, health issues, food preferences, interaction between staff, resident and family, end-of-life care, mental health, and religion and spirituality. Each chapter author is able to achieve a balance between a broad overview of historical factors and specific implications for practice. For example, in her chapter on older African Americans, Molly Davis discusses their ancestry, the revered role of older adults in African and African American culture, institutional racism, and historical patterns of family life. Davis uses a case study to illustrate the diversity that exists among African Americans by describing three very different resident experiences moving to a nursing home and adjusting to life there. The three cases reflect how class, educational status, facility location, and perceptions of family caregiving roles can influence the nursing home experience among older African American adults. In the chapter "American Indian Elders," Priscilla Day discusses how the adults who lived during the "boarding school era" (a period of time when Indian children were removed from their families and communities and placed in boarding schools in order to replace tribal culture and language with mainstream culture) may perceive living in a nursing home negatively because of their early-life experience. Both Yvette Solis-Longoria and Maria Cuadrado provide insight into the concept of personalism (help-seeking from informal support systems) in their separate chapters on older Puerto Ricans and Mexican Americans, emphasizing the importance of interacting with elders from Latino cultures in a warm caring manner to build rapport, instead of with a professional yet distanced approach. These nuances of cross-cultural communication, understanding, and interaction are just a few illustrations of the importance of culturally competent practice when working with diverse populations. Professionals at all stages of their careers will benefit from the rich content of the chapters on elders representing eight ethnic/racial groups.
Supervision in Gerontological Social Work Practice
Initially, one may wonder about the need to specifically address supervision with gerontological social workers when there are other books on supervision for social work practice generally. However, Burack-Weiss and Brennan demonstrate in each chapter why this type of book is needed in the field. Aging practice has emerged as an area of specialty in the social work profession, but the existing supervision textbooks and aging literature have not been integrated. Social workers have long been actively involved in gerontological practice but have not had a "how to" guide for supervisors engaged in aging practice. Although this book is focused on supervision within organizations, Burack-Weiss and Brennan integrate practice implications throughout to illustrate very well the relationship between supervision and client/staff interactions.
This book's second edition is a practical resource for social workers who supervise case managers, direct care workers, and interns who work with older adults. Part one outlines supervision in gerontology, the stages of the helping process, and learning and teaching styles congruent with the social work profession. The authors conceptualize the social work perspective of supervision as a combination of four interrelated concepts: parallel process, the power of relationship, a holistic approach, and a dual emphasis on the person and their environment. The parallel process is the congruence between the values and skills present during the supervisor's interaction with the social worker and the social worker's interaction with his/her clients. Relationships between supervisors, employees, clients, and their families are a critical element in the professional relationship in gerontological social work. The strength of these relationships can significantly impact client outcomes because they can influence how intervention goals are achieved. The holistic approach to supervision and the dual emphasis between the person and their environment integrates the physical, social, psychological, cultural, and spiritual facets of clients with the multiple systems and institutions in which they are involved. The strengths-based approach to practice is central to supervision because it assumes that each person involved in the professional relationship is an active participant in the change process and possesses existing skills, knowledge, and capacity. The authors provide practical strategies for incorporating the strengths perspective into the relationships between the social worker, the older adult, and his or her family.
The technical components of the professional relationship, interviewing, the problem-solving model, empowerment, mediation, and advocacy are highlighted. One of the greatest challenges for social workers is determining an optimal balance between the professional intervention and the strengths perspective that fosters client independence. Each chapter in part two incorporates examples drawn from the authors' experience supervising workers to illustrate the central ideas related to self-determination, client engagement, and empowerment. In chapter five, the authors differentiate between social workers "doing with" and "doing for" advocacy and mediation. This is an important distinction because "doing with" implies sharing the work while "doing for" is acting on behalf of the older adult. Both approaches may be appropriate at different points in the relationship between the social worker and the older adult, but it will be important for the supervisor to guide the staff as they make this determination.
The book considers the organizational context, staff development, and difficult conversations involved in supervision. Since supervision does not occur in isolation, the authors examine how organizational structure influences the type, level, and quality of supervision and opportunities for staff development. They also provide suggestions for addressing sensitive topics with staff through scenarios and 10 practical questions that can be used to guide the discussion. This section is particularly useful for social workers who are new to supervision because it summarizes the "best practices" drawn from the authors' years of experience.
Different supervisory tasks are associated with interns and paraprofessional workers. When organizations accept interns, it is important to remember that the interns are not full-time employees. The authors challenge supervisors to perform an assessment of their organization's capacity to support and appropriately use interns in their daily operations so that the internship experience is positive for the organization and the student. Group supervision is an option when more than one intern is placed at the organization, and the book provides suggestions for managing the process and ideas for group projects.
Like interns, direct care workers (paraprofessionals) confront specific issues that should be considered in supervision. The authors translate their model of social work supervision to this group of workers who assist older adults with daily living activities. Since these workers work in the home and in residential settings, an emphasis is placed on clearly defined roles and maintaining professional boundaries. The authors acknowledge the low status of the direct care workers and briefly discuss how this status may limit the supervisory relationship because of staff turnover due to low wages and minimal job security. This is an example of how environmental factors (the economy, applicant pool) may affect the quality of services available to older adults. Without an understanding of the interrelatedness between supervision, the organizational context, and practice, it will be impossible for social workers to deliver quality services.
In conclusion, these three important yet different books represent a spectrum of issues related to an ecological approach to working with older adults, and would be a welcomed addition to any gerontological social work library. The theme of balance between organizational and client priorities and the reciprocity between the two is central. In order to work effectively with older adults, social service providers must have the capacity and resources to support gerontological social work. Competent staff, quality supervision, and service delivery models that reflect the diversity of older adults will facilitate positive client interactions and outcomes. These books are useful resources for students and professionals as they develop and refine the knowledge and skills integral to gerontological social work practice.
References
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