Leslie Hasche

Differences Across Age Groups in Transgender and Gender Non-Conforming People’s Experiences of Health Care Discrimination, Harassment, and Victimization

Objective: Given the increasing diversity among older adults and changes in health policy, knowledge is needed on potential barriers to health care for transgender and gender non-conforming (GNC) individuals. Method: Using the 2010 National Transgender Discrimination Survey (NTDS), logistic regression models test differences between age groups (below 35, 35-49, 50-64, and 65 and above) in lifetime experience of anti-transgender discrimination, harassment, and victimization within health care settings while considering the influences of insurance status, level of passing, time of transition, and other socio-demographic factors. Results: Although more than one fifth of transgender and GNC individuals of all ages reported health discrimination, harassment, or victimization, significant age differences were found. Insurance status and level of passing were also influential. Discussion: Medicare policy changes and this study’s findings prompt further consideration for revising other health insurance policies. In addition, expanded cultural competency trainings that are specific to transgender and GNC individuals are crucial.

Comparison of major depressive disorder and subthreshold depression among older adults in community long-term care.

Objectives: This study extends existing knowledge regarding the continuum between major depression (MD) and subthreshold depression (SD) by examining differences in symptomology and associative factors for a subpopulation of older adults with functional disability. Method: Our sample consisted of clients age 60 and above entering public community long term care derived from the baseline survey of a longitudinal study (315 non-depressed, 74 MD, and 221 SD). We used the Diagnostic Interview Schedule to establish diagnoses of MD, the Center for Epidemiological Studies Depression Scale (CES-D) to assess SD, and other self-report measures to explore potential associative factors of demographics, comorbidity, social support, and stressors. Results: No differences in CES-D identified symptoms occurred between the two groups. MD and SD were both associated with lower education, poorer social support, more severe medical conditions, and higher stress when compared to non-depressed older adults. Younger age and being female were associated solely with MD; whereas, worse perceived health and more trouble affording food were associated solely with SD. The only associative factor significantly different between MD and SD was age. Those with MD were more likely to be younger than those with SD. Conclusion: Our findings of symptom profiles and associative factors lend support to the continuum notion of depression. Identification of only older adults within the community long-term care service system who meet criteria for MD would leave many older adults, who also face multiple comorbidities, high levels of stress and social isolation, and substantial depressive symptoms undiagnosed and untreated.

Adapting Collaborative Depression Care for Public Community Long-Term Care: Using Research–Practice Partnerships

This manuscript details potential benefits for using a research–practice partnership to adapt collaborative depression care for public community long-term care agencies serving older adults. We used sequential, multi-phase, and mixed methods approaches for documenting the process of adaptation within a case study. Systematic adaptation strategies are described, such as leveraging long-term research–practice collaborations, consulting with multiple stakeholders across all levels and disciplines, and balancing demands to monitor treatment fidelity, clinical outcomes, and implementation results. These examples demonstrate that researchers interested in implementation science need skills to negotiate the competing demands that arise from both the research and practice settings.

Making Time for Dissertation Grants: Strategies for Social Work Students and Educators.

Grant writing is a necessary skill for becoming an independent and successful social work researcher. Since social work dissertation grants are a relatively new trend, students face many challenges in identifying, preparing, and submitting dissertation grants. Lack of resources and experiences, difficulties in protecting time for grant writing, and the uncertainty of success can hinder work on dissertation grants. Thus, this article provides an overview of dissertation grants, including a review of grant mechanisms, suggestions for preparing grants in the context of program milestones, and identifying institutional infrastructure to facilitate submissions. Strategies discussed include how to learn about funding priorities, how to establish timelines to account for grant deadlines, and how to use peer reviews to guide the revision process.

Successful Strategies for Discharging Medicaid Nursing Home Residents with Mental Health Diagnoses to the Community

ABSTRACT The state and federal push to transition Medicaid residents from nursing homes to the community calls for effective discharge strategies targeted to residents’ diverse needs. This exploratory, mixed-methods study utilized the Minimum Data Set to describe demographics, health characteristics, and transition patterns of Kansas Medicaid residents with mental health diagnoses who were discharged from nursing homes from 2005 to 2008. Discharged residents (n = 720) had multiple comorbidities, and more than half remained in the community following their first nursing home event. In-depth interviews with nursing home staff (n = 11) explored successful discharge strategies. Successful strategies support an ecological approach to meeting individual, family, organizational, and community needs. This includes creating/sustaining a culture of discharge, encompassing informal and formal community supports in the discharge process, proactively addressing physical environment needs, and assisting individuals and their family members in managing physical and mental health conditions. Findings suggest that policies in the areas of preadmission screening, caregiver support, and revised Medicaid reimbursement are needed to better support continuity of care and promote discharge for nursing home residents with complex care needs. Future research could examine individual and family perspectives on the discharge process and track outcomes when transitioning between settings.

Implementing collaborative care for late-life depression in community long-term care.

Collaborative care models have improved accessibility and quality of depression care (Unützer et al., 2002). Key elements include depression care management with psychiatric supervision, a stepped care algorithm, and systematic depression screening (Steinman et al., 2007). The National Council on Aging and the Center for Disease Control and Prevention are promoting both the dissemination of collaborative care and its adaptation for other settings. Every state provides community long-term care (CLTC) to low-income, disabled older adults through information and referral, case management, in-home, and community-based services. Depression rates are about 25% in CLTC, suggesting the value of improving this system’s response to depression (MorrowHowell et al., 2008). Our treatment development project, implemented and evaluated an adapted collaborative care model for depressed older adults in CLTC. We adapted the Improving mood-Promoting Access to Collaborative Treatment for primary care (IMPACT) (Unützer et al., 2002) and Program to Encourage Active Rewarding Lives for Seniors (PEARLS) (Ciechanowski et al., 2004) treatment models in an iterative process with an expert panel including project investigators; national collaborative care experts; and local geriatric, primary care, and CLTC consultants. Implementing collaborative care in CLTC required working across CLTC, primary care, specialty mental health, and other service systems; a unique challenge because of each client’s independent primary care provider. Below, we report feasibility, acceptability, and clinical outcomes our project for CLTC. Participants were recruited through public CLTC agencies in a large Midwestern metropolitan area. Washington University’s Institutional Review Board approved the study procedures. For all eligible participants, the depression care manager (with consultation from the geriatric psychiatrist) developed treatment plans based upon diagnosis (major depression, dysthymia, or minor depression) and participant treatment preferences for psychotherapy and/or antidepressant medication. Treatment plans were shared with the CLTC caseworkers and primary care providers. Treatment course followed a standard algorithm of treatment response and was flexible to meet the needs of each individual client. Of the 151 CLTC clients approached, 83 (55%) screened positive for depression. Of those, 34 (46%) were not eligible (e.g., cognitive impairment, other psychiatric disorders, current psychiatric treatment) and 19 (26%) refused. Twenty-one (28%) enrolled into the project (average age, 70 years; 19 females; 70% white people). Sixteen participants completed the entire protocol; two died during treatment (because of comorbid medical conditions), two dropped out of treatment, and one participant was withdrawn for non-compliance with treatment. Table 1 highlights clinical characteristics and outcomes. Including case management, travel, and documentation, the average amount of time per participant/ per week required was about 1h. Acceptability of depression screening was satisfactory per caseworker’s rating of ease and understandability to their clients. Only five CLTC clients refused the depression screening. On average, Patient Health Questionnaire PHQ-9 (Kroenke et al., 2001) scores significantly decreased between treatment initiation and discharge. At discharge, 15 of 21 participants scored in the mild to minimal range of depression symptoms and 74% of participants had ≥50% reduction in depressive symptoms. To our knowledge, this is the first study to examine collaborative care in publicly funded CLTC settings. This project offered a new approach to improving depression care for older adults in community settings. In spite of challenges (CLTC caseworkers, the primary care physicians, and depression care managers operating under different agency infrastructures, with unique client records, varying treatment protocols, and use of consultation), we found that this adapted model was feasible, acceptable, and yielded positive clinical outcomes. Yet, concerns are raised about the fit of collaborative care models alone in CLTC settings. First, for bureaucratic reasons, the depression care manager was not co-located in any CLTC agency, which limited our ability to coordinate care, provide education, or ensure screening and referrals were completed. Second, coordinating care with the numerous physicians was

Exploring how workplace and social policies relate to caregivers’ financial strain

ABSTRACT Informal caregiving is a critical component of the US long-term care system, but can have significant negative impacts on caregiver employment, finances, and well-being. An online survey of Colorado caregivers was piloted in 2016–17 to explore whether workplace and social policies such as access to paid family leave and public health insurance can buffer the negative financial impacts of caregiving and help caregivers to remain in the workforce. Using standardized measures, the survey assessed caregivers’ employment and financial status, well-being (physical and mental health, caregiver strain, benefits of caregiving), access to workplace supports, and covariates (e.g., caregiver demographics, health, social support, and service utilization). Ninety-five caregivers, recruited through community agency partners, completed the survey. Respondents were predominately female (89%), middle-aged (M = 57), non-Hispanic White (64%) or Latino/a (22%), and caring for a parent (40%) or spouse (30%) for over one year. Half (51%) reported working full- or part-time jobs, while 16.4% had stopped working because of caregiving. In multivariate regression modeling, predictors of financial strain included the care recipients’ financial strain and the caregiver’s reduction or ceasing of work. Medicare may be protective to minimize caregivers’ need to reduce or cease work. Implications for caregivers’ ability to stay engaged in the workforce and prepare for their own retirement are explored.

Applying a social model of disability across the life span

ABSTRACT With an estimated 21.3% of persons aged 15 and older experiencing disability in the USA, social workers will see clients present with disabilities across all practice settings and stages of human development. Yet, the training and terminology of social workers—which often closely aligns with medical professionals—may seem to occur in isolating silos or disciplinary theories. Social work education often views the needs of older adults and people with disabilities as two distinct populations, despite the fact that many of these individuals share similar needs for access, resources, and support. Furthermore, when discussing human development, the focus may skew to individual affective, behavioral, and cognitive processes and indicators of abnormal development and frailty. Thus, by clarifying terminology and applying a social model of disability across the life span, we identify how educational efforts related to human behavior and the social environment can promote intersectional and inclusive social work related to aging and disability.

Counseling People with Early-Stage Alzheimer’s Disease: A Powerful Process of Transformation, by Robyn Yale

With over 44 million people living with dementia around the world, and projections nearly tripling that rate by 2050 (Alzheimer’s Disease International, 2013), the demand for dementia-specific interventions and practitioners is high. As early detection becomes more common (Cordell et al., 2013), it is essential that intervention responses are available to help persons with early-stage dementia. Unfortunately, the current state of knowledge and gerontological workforce is seen as unprepared and facing a shortage (Institute of Medicine, 2008). This book, Counseling People with Early-Stage Alzheimer’s Disease: A Powerful Process of Transformation, offers a valuable resource for practitioners and students across helping professions to implement an innovative counseling protocol for persons with early-stage dementia. The author, Robyn Yale, draws on over 30 years of gerontological social work experience and her pioneering work in developing support groups for persons with early-stage dementia. Throughout the book, Yale integrates conceptual and practice-based knowledge to describe a counseling protocol that address the emotional, practical, and lifestyle challenges faced by persons with early-stage dementia. It is a great example of how innovative practices can be explicated to support the spread of knowledge, services, and a prepared workforce for promoting the well-being of persons living with dementia. To start, Yale describes the history of services for people with earlystage dementia and offers an overview of key terms (i.e., Alzheimer’s disease, early-stage, mild cognitive impairment). She wisely includes an argument that counters existing stigma and debunks questions of if persons with early-stage dementia can engage in counseling. Yale describes what makes counseling persons with early-stage dementia distinct from counseling in general and the potential benefits of such work. This background information sets the stage for a description of the conceptual framework for coping with early-stage dementia that is offered in Chapter 2 and further specified through examination of the related challenges in Chapter 3. Chapters 4 and 5 offer tips for adapting the counseling

“As Needed” Case Management Across Aging Services in Response to Depression

A lack of clarity on how and where case management for older adults is delivered persists, even as evidence supports its use to respond to depression. We used in-depth interviews with managers (n = 20) and staff surveys (n = 142) from 17 service agencies to explore the provision of case management services in adult day services, homecare, senior centers, and supportive housing. Limited case management services were found. Barriers included limited time and resources, especially for senior centers and supportive housing. Results revealed a concern about the role, feasibility, and availability of case management for older adults within these settings.