Social Work Practice with Older Adults

Introduction: Shifting Perspectives in Gerontology

Part 1: Research and Theoretical Background of the Resilience-Enhancing Stress Model

Chapter 1: Narrative Gerontology: Research-Informed Practice
Chapter 2: A Resilience-Enhancing Stress Model Multitheoretical Base

Part 2: Introduction to the Resilience-Enhancing Stress Model’s Narrative Interview

Chapter 3: Resilience-Enhancing Stress Model Interview Skills: Engaging the Client in Self-Understanding
Chapter 4: The Resilience-Enhancing Stress Model Narrative Interview: Facilitating Role Transitions across the Life Course
Chapter 5: The Narrative Interview: Human Rights, Diversity, and Older Adults

Part 3: Assessment of and Intervention in the Individual–Family–Community Configuration

Chapter 6: Biopsychosocial and Spiritual Processes: Cocreating and Reconstructing Client Narratives
Chapter 7: Family-Focused Social Work Practice: Cocreating and Reconstructing a Family Narrative
Chapter 8: Examining Resilience in an Intergenerational Refugee Family
Chapter 9: Macro Practice in Resilience-Enhancing Stress Model Geriatric Social Work

References
Index
About the Authors

Harriet L. Cohen, PhD, is a retired university professor of social work who taught at Texas Christian University School of Social Work, including courses in diversity and human behavior. She now serves as a clinical geriatric practitioner at the Jewish Family Service of Dallas, providing grief and loss counseling. She also is a researcher and an activist in the LGBTQ community.

Taunya S. Cole, BS, is a registered nurse, author, and writer. Currently, she resides in Reno, Nevada, and her experience as a nurse stretches across 26 years of practice in critical care, long-term care, and pediatric home care, which is her current area. With a passion for health literacy, preventive health, and holistic health, she took her career to another level in January 2018 when she founded Rewrite Health to help people gain optimum health.

Nicole M. Dubus, PhD, is an assistant professor of social work at Norfolk State University in Virginia. She was an associate professor in social work at San José State University and a licensed clinical social worker with almost 30 years of experience. She has worked in private social service agencies, health and behavioral centers and hospitals, as well as county and state agencies. Her research has focused on the health and behavioral health needs of refugees and forced migrants and on culturally effective practice for these populations. She was a Fulbright Specialist assisting Iceland’s resettlement of Syrian refugee families.

Nancy A. Greene, DSW, MA, is an adjunct professor of social work at Johnson C. Smith University School of Social Work. She teaches courses in human behavior and gerontology. In addition, she has taught online classes in social work for Tulane University and Grand Canyon University. She is a licensed practitioner who has worked for home health care and hospice agencies. She currently provides international telehealth services.

Roberta R. Greene, PhD, MSW, professor emerita, was the Louis and Ann Wolens Centennial Chair in Gerontology and Social Welfare at the University of Texas at Austin; she also was dean at Indiana University School of social Work. She has a wide range of clinical, policy, administrative, and research practice experience. She is an NASW Social Work Pioneer, known for her advocacy work on nursing home reform. She was the 2015 recipient of the Knee/Whittman Outstanding Achievement Award, which recognizes those who have made a significant impact on national health, public policy, or professional standards. She has served on the Council on Social Work Education’s Commission on Educational Policy. A fellow of the Gerontological Society of America, she has conducted significant research on resilience among Holocaust survivors. A prolific author, she has written numerous books, six of which are on resilience. Others include the Handbook of Human Behavior and the Social Environment: A Practice-Based Approach (Aldine Transaction Press, 2017), Caregiving and Care Sharing: A Life Course Perspective (NASW Press, 2014), and Human Behavior Theory and Social Work Practice with Marginalized Oppressed Populations (Routledge, 2019).

Michael A. Wright, PhD, LAPSW, holds a doctorate in social work from the University of South Carolina with a specialty in technology. He is a licensed advanced practice social worker and former university professor with almost 20 years of experience and specializations in human behavior and macro practice. He continues to teach training events both online and in person.

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Geriatric social workers need to keep abreast of the shifting perspectives in gerontology and the revisioning of social work practice. This text presents the resilience-enhancing stress model (RESM) and describes its use in geriatric social work practice, demonstrating how it can be used to further choice and resilience in older adults.

Defining Gerontology

Historically, gerontology has been defined as “the study of the aging process and the problems that elderly individuals might encounter,” a definition suggesting that all older people experience a time of deterioration and decline that is insurmountable (Careers in Psychology, 2019, p. 1). This is an erroneous definition. Instead, gerontology is the study of a specific population group, encompassing biology, sociology, psychology, the humanities, and other academic disciplines that examine the changes associated with the aging process. This new definition increasingly affords an understanding of the variation in how the aging population functions across time (Kiyak & Hooyman, 1999; Peluso, Watts, & Parsons, 2013). When social workers use this knowledge, their actions need to be translated into practice for specific individuals, their families, and their communities.

New Gerontology

Sociocultural and positive psychological frameworks have resulted in what is known as the “new gerontology” (Galambos, Greene, Kropf, & Cohen, 2018), which offers a positive view of older adults’ roles and opportunities. New gerontologists argue that if social workers want to enhance the well-being of an older adult, they must learn how a client wants to live out their life (Kivnick & Murray, 2001). The RESM presented in this text enables practitioners to do just that.

Leaders in Gerontology

This geriatric practice guide would not be possible without the work of pioneer gerontologists, such as Robert Butler, James Birren, and Elaine Brody. Robert Butler, a geriatric psychiatrist, originated the term life review as “a progressive return toconsciousness of memories and unresolved past conflicts for reevaluation and resolution,”a perspective that he applied in his geriatric practice (1969, p. 134). Butler’sviews foreshadowed the philosophical essence of social work practice with olderadults embodied in the RESM. He said,

Put succinctly, the psychotherapy of old age is the psychotherapy of grief and of accommodation, restitution, and resolution. [It is a time of] “‘coming to terms with,’ ‘bearing witness,’ reconciliation, atonement, construction, and reconstruction, integration, transcendence, creativity, realistic insight … and the introduction of meaning.” (Butler, 1969, p. 237)

James Birren (1959), a gerontological researcher who pioneered the guided autobiographical approach, introduced the concept of functional age. The interconnected factors of functional age remain at the heart of a geriatric assessment as incorporated in RESM. Functional age refers to biopsychosocial and spiritual factors that affect older adults’ ability or competence central to everyday life functioning. Biological factors include health, physical capacity, and the well-being of vital life-limiting organ systems. Psychological factors encompass affective moods, cognitive or mental status, and adaptation. Sociocultural aspects of functional age are related to cultural, political, and economic aspects of life, while spiritual factors involve faith communities and belief systems.

Elaine Brody, a social worker and gerontological researcher, opened professionals’eyes to the issues families face when the grandparental generation needs care. She suggestedthat when an older family member is cared for at home, a large measure of thatresponsibility falls on female relatives. This family task is often made difficult for the adultchild, who may also be involved in child care and have employment outside the home.Brody (1981) called this group the “sandwich generation.” She also called parent care “normativefamily stress” (Brody, 1985). Her work led to a greater interest in treating the familof later years as a caregiving system. This text continues to build on this pioneering work.

Further Defining Geriatric Specialized Practice

These positive points of view of aging are mirrored by theorists who have been revisioning geriatric social work practice. According to the Council on Social Work Education (CSWE, 2015b), geriatric social workers are not concerned only with older adults with functional impairment. They also recognize “the strengths, resilience, and contributions of older adults to families, communities, and society” (CSWE, 2015b, p. xiii). In addition, practitioners address diversity and the “social determinants of health and well-being, as well as structural inequities facing older adults by race, gender, ethnicity, immigration status, sexual orientation, social class, functional ability, and religion” (CSWE, 2015b, p. xiii). These emphases appear throughout RESM practice.

How This Book Is Organized

This book is divided into three parts. The first part outlines the research and theoretical background of RESM. The second offers an introduction to RESM’s narrative interview used in engagement, assessment, intervention, and evaluation at multisystem levels. The third presents assessment of and intervention in the individual–family–community configuration.

Chapter 1 summarizes research studies of older adults who have survived the discriminatory practices of Jim Crow in the U.S. South. Chapter 2 provides an overview of the RESM theory base and how it serves as a guide for geriatric social work practice. Chapter 3 describes how practitioners use the narrative interview as a means of engaging clients and forming a client–social worker relationship. Chapter 4 explores how social workers facilitate clients’ role transitions and performance to reconstruct a more positive client narrative. Chapter 5 discusses the RESM interview and how it is used to support resilient social functioning among marginalized populations at the macro level. Chapter 6 describes the geriatric RESM assessment and intervention processes used to address problems of daily living faced by older adults and their families. Chapter 7 discusses RESM from a family systems perspective. An assessment is made of a family’s caregiving potential. Chapter 8 explores how a refugee family balanced risk and protective factors on its journey to the United States. Finally, chapter 9 examines how communities perform the functions that enable individuals and families to deal with disruptive stressors and sustain resilience.

Each chapter concludes with an RESM Toolbox section that lays out how theory translates to practice, poses discussion questions, and provides ideas about how to apply RESM. These toolboxes give the practitioner ideas about how to enter the client–social worker encounter ready to hear client narratives (Greene & Blundo, 1999). Toolboxes provide exercises that promote active listening and the interpretation of a client’s story. When taken together with the many practice examples, practitioners obtain a foundation in geriatric social work practice.