There are an estimated 11,000 new cases of spinal cord injury (SCI) in the United States per year. Over the last several years, SCI has primarily affected persons aged 16 – 30, 78 percent of whom are males; and predominately Caucasian (78 percent).

Almost half of the spinal injuries occur as a result of motor vehicle injury, second are falls, and the remainder come from acts of violence such as gun shot wounds or knife injuries as well as war related injury.

SCI is defined as, damage or trauma to the spinal cord that results in loss of sensory and motor function. An SCI can result in either a “complete injury” (a loss of all voluntary movement) or an “incomplete injury” (a partial loss of voluntary movement).

An SCI is classified utilizing a scale developed by the American Spinal Injury Association (ASIA) that uses a system to describe the level of injury. For example, a person with an ASIA A complete injury describes a person who has no voluntary movement or sensation below the level of injury.

Dealing with the Diagnosis

Spinal cord injury (SCI) is a devastating event that not only has physical but social and psychological ramifications for both the individual and the family. In one moment, a person’s world is monumentally changed forever with reverberations throughout the whole family system. The person who sustains an SCI is at high risk for many factors including: dependency, depression, drug addiction and, if married, divorce. They can also struggle with debilitating secondary medical complications and other factors such as the effects of perceived social discrimination, declining help and lack of social, family, and emotional support.

Family Implications

When something traumatic happens to one family member, the whole family feels the effects. Roles and responsibilities change. Marital strain occurs when one partner has to take on unfamiliar roles such as providing assistance with activities of daily living, financial responsibility and intimacy changes. This can put the person without the disability at high risk for depression.

Parents who have a young adult child that has an SCI will often reestablish the role or responsibility of parenting. If the person has left home, this may mean moving back in. This can affect self-esteem of the person with SCI and cause conflict with parents.

Interpersonal relationships are affected as well. Friends who may have had previous interests or activities they enjoyed doing together are now different. The person with SCI may withdraw or may feel embarrassed being seen post-injury. While having a young child sustain a spinal cord injury, brings a new dynamic to the entire family system and numerous challenges to the child who must face an SCI during times of dynamic growth and development. (more…)

Introduction

In recent years, medical advances have produced revolutionary treatments for people with HIV that slow the progression of the disease and prolong life. Unfortunately, various strains of the HIV virus are also evolving, becoming increasingly resistant to drug treatments, which may lead to the drugs or medication therapies failing. Genetic testing is now used for people with HIV to help identify drug-resistant HIV strains so that physicians can prescribe the most effective treatment options.

HIV (human immunodeficiency virus) is a disease that destroys or damages a type of white blood cell (CD4 T-cells) in the immune system and progressively decreases the body’s ability to fight infections and certain cancers. The virus causes AIDS (acquired immune deficiency syndrome).

People with AIDS have a significantly reduced number of healthy white blood cells, and therefore become more susceptible to life-threatening infections caused by microbes that rarely cause illness in healthy people.

Although there is no cure, treatment for HIV has advanced with highly active antiretroviral therapy (HAART), which suppresses the virus. However, HIV is constantly replicating and can mutate so that antiretroviral medications designed to treat a certain strain of virus are no longer effective.

Drug resistance is the most common reason why medication therapies fail. People with HIV may have several different strains of the virus, so determining the optimal treatment option becomes more difficult.

Types of Genetic Tests

Two types of genetic tests are available to determine if a resistant strain of HIV is present in a person using HAART: phenotype and genotype testing. Phenotype testing measures the amount of drug required to completely stop HIV replication in a blood sample. In contrast, genotype testing identifies the mutations in the genetic structure of the virus that have been linked with drug resistance.

Genetic analysis of HIV/AIDS helps researchers to better track the patterns of disease transmission, and to better understand how the virus affects the human body. No one test is sufficient for making treatment decisions.

People with HIV/AIDS work with a variety of professionals who diagnose and treat the disease and help manage the physical and mental health and social issues related to the disease. Social work professionals play an important role in the disease management team.

Social workers employed in community human services agencies, hospitals, and in private practice help people with HIV/AIDS to decide whether or not to have genetic testing and to understand the implications of test results. Additionally, social workers coordinate community services and help their clients address the life changes that often accompany a diagnosis of this life-threatening disease.

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Source material:  HIV/AIDS: Understanding the Role of Genetics by Evelyn P. Tomaszewski, MSW, published in the NASW Specialty Practice Sections Health Connection, Spring 2005.

Related Articles:

• About HIV/AIDS
• HIV/AIDS Current Trends
• HIV/AIDS: Your Options
• HIV/AIDS: How Social Workers Help
• HIV/AIDS Tip Sheets
• Resources on HIV/AIDS
• HIV/AIDS Real Life Stories

Infertility is an experience that strikes at the very core of one’s life. Reproduction is considered the most basic of human needs, propelled by powerful biological and psychological drives. When the ability to reproduce is thwarted, a crisis ensues and impacts relationships with others, life goals, social roles, and sense of self. A host of emotions emerge in a somewhat predictable and repetitive process as one moves through medical diagnosis and treatment. Feelings of disbelief, anger, sadness, guilt, blame, anxiety and depression can be overwhelming and finding appropriate avenues to express these emotions is important.

For most people, in vitro fertilization (IVF) is not the first course of treatment for their infertility—it is the last, best option for having a child. It occurs after long months and sometimes years of treatment failure, often at tremendous emotional, physical and financial cost. Couples beginning IVF usually do so with the burden of grief and disappointment from infertility, and may feel depressed, angry, tired, and anxious. Although emotionally depleted, couples are attracted to a technology that offers hope where none may have existed. They find themselves drawn into new emotional turbulence of contrasting feelings of hope and despair, which seems to be generated in part by the experience of the technology itself.

The opportunities that IVF creates brings with it significant challenges. IVF is considered by patients to be the most stressful of all infertility treatments. Patients have rated the stress of undergoing IVF as more stressful than or almost as stressful as any other major life event, such as a death of a family member and separation and divorce. While general assumptions may be made about stress levels during IVF, the experience for infertility patients will be personal and unique—each patient will experience the stress differently based upon his or her own personality and life experiences.

The aspects of IVF that are perceived stressful to patients are multifaceted and affect all parts of their life: marital, social, physical, emotional, financial, and religious. Time is stressful, both in the time commitment to an intense treatment which leads to disruption in family, work, and social activities, and for some, in long waiting periods for treatment services. IVF stress impacts the marital relationship with an emotionally laden experience and, by removing the conjugal act of procreation, sexual intimacy is lost. Couples, also, are stretched financially paying for the high cost of IVF treatment with a relatively low probability of success. Dealing with the medical staff and with the side effects or potential complications of medical treatment has its own stress: hot flashes, headaches, mood fluctuations, shots, sonograms, future health concerns, and decision making about embryos and multiple pregnancies. Religious, social, and moral issues may also make IVF stressful, especially for those dealing with third party reproduction, when these values are in conflict with the choice of treatment.

The first treatment cycle has been found to be the most stressful for patients, with high levels of confusion, bewilderment, and anxiety. This may be due to inexperience with the process or possibly inadequate preparation of the patient by staff in terms of information and discussion of care. While experience seems to help the stress level in the next cycle, if it is unsuccessful the stress level rises again with the third cycle as the “stakes” have been raised. For many couples, IVF can feel like gambling where the stakes are high and the chance of success unknown. Like gamblers, some IVF patients may have unrealistically high expectations of success or feel compelled to try “just one more time” finding it difficult to end treatment after having already invested so much physically, emotionally, and financially to have a child.

Within a treatment cycle, patients view IVF as a series of stages which must be successfully completed before moving onto the next phase of treatment: monitoring, oocyte retrieval, fertilization, embryo transfer, waiting period, and pregnancy test stages. The level of stress, anxiety, and anticipation raises with each stage, peaking during the waiting period. Research has shown that in order of perceived stress for patients, waiting to hear the outcome of the embryo transfer is the most stressful, followed by waiting to hear whether fertilization had occurred, and then the egg retrieval stage. Patients are aware of the importance of these key phases in the IVF process and the uncertainty of the outcome is highly distressing.

Despite the stressful consequences of infertility and IVF, it is important to note that research has shown that the vast majority of patients are well adjusted. Further, there seems to be no long-term impact on the marital relationship and individual functioning. In fact, some research has shown that the crisis of infertility may actually improve marital communication and emotional intimacy. Couples may learn coping skills and communication patterns that provide life-long benefit.

IVF has the potential to be an emotionally, physically, and financially exhausting experience due to the “high stakes” and “end of the line” nature of this treatment. Thus, patients need to consider thoughtful preparation before beginning the process. If you are a patient about to begin a cycle, here are some tips to help get ready for IVF. (more…)

Excerpt from the U.S. Department of Eldercare Locator
Reviewed by NASW Office of Social Work Specialty Practice Staff

Today, family caregivers have options to choose from when they need assistance or respite. And, highly trained and experienced social workers are available to help caregivers sort through the range of available options.  Below is a brief description of some of the caregiving services commonly available. 

Adult Day Care

Adult Day Care Centers are designed to provide care and companionship for seniors who need assistance or supervision during the day. The program offers relief to family members or caregivers and allows them the freedom to go to work, handle personal business or just relax while knowing their relative is well cared for and safe.

The goals of these programs are to delay or prevent institutionalization by providing alternative care, to enhance self-esteem and to encourage socialization. There are two types of adult day care: Adult social day care provides social activities, meals, recreation, and some health-related services. Adult day health care offers more intensive health, therapeutic and social services for individuals with severe medical problems and those at risk of requiring nursing home care.

How Do Adult Day Care Centers Operate?

These centers are usually open during working hours and may stand alone or be located in senior centers, nursing facilities, churches or synagogues, hospitals, or schools. The staff may monitor medications, serve hot meals and snacks, perform physical or occupational therapy, and arrange social activities. They also may help to arrange transportation to and from the center itself.

Assisted Living

Assisted living facilities offer a residential alternative for older adults who may need help with dressing, bathing, eating, and toileting, but do not require the intensive medical and nursing care provided in nursing homes.

Assisted living facilities may be part of a retirement community, nursing home, senior housing complex, or may stand-alone. Licensing requirements for assisted living facilities vary by state and can be known by as many as 26 different names including: residential care, board and care, congregate care, and personal care.

Assistive Technology

Assistive technology is any service or tool that helps the elderly or disabled do the activities they have always done but must now do differently. These tools are also sometimes called “adaptive devices.”

Such technology may be something as simple as a walker to make moving around easier or an amplification device to make sounds easier to hear (for talking on the telephone or watching television, for instance). It could also include a magnifying glass that helps someone who has poor vision read the newspaper or a small motor scooter that makes it possible to travel over distances that are too far to walk. In short, anything that helps the elderly continue to participate in daily activities is considered assistive technology.
[Click here for the full article]

Note: All names have been changed to protect confidentiality.

By L.B. (LeslieBeth) Wish, Ed.D, MSS

Introduction

Sally had been a soldier’s wife for all twelve years of their marriage. She endured separations while her husband, Tom, was called to duty, and she toughed out raising twin boys alone. Sally said Tom loved her because, in his words, she was a “team player.” But ever since Sally learned that Tom was killed in a roadside bomb in Iraq, Sally doubts whether she can be a team of one. “I’m really not that strong,” Sally said. “It’s just a good act.”

When Rolanda was shot out of her helicopter, her husband Ray said he had no choice but to “pull himself together.” He had to focus on his job and raising his stepdaughter. “I only cry at night, and then only for a second or two. We were practically newlyweds. I don’t even know what I’ll be missing.”

“At least the kids are grown.” It was the first thing that came to Linda’s mind when she heard that her husband was killed in an ambush. But the relief was short—depression set in, and Linda felt “ashamed” for falling apart.

These stories provide a glimpse into the plight of many of the American families of downed warriors in Iraq. Each family’s grief is unique, but most share issues that are familiar to mental health professionals–adjustment, loss, grief, and anger.

Some families rely on friends, the Armed Forces community, and supportive family for help. But one of the issues that many (certainly not all) of these families also share is their reluctance to use the mental health services available to them.

Why? What makes providing counseling to these families so different from non-military families in mourning? And how can mental health professionals serve these families’ needs?

Let’s start with learning a little more about some of these families. Bear in mind, that there are many reactions to the loss of a family member and that not all families of downed warriors react the same. Yet, a constellation of beliefs, fears and adjustment issues does exist amongst many of these families, and it is important to become familiar with them.

Current Issues of Some American Military Families

At first, it seems that the most common issues of military families do not differ from the problems of families not in the military. People are people, as some say. After all, humans share common problems. Yet, military families often add elements to these issues that are unique to them.

Fear of Being “Found Out”

Many families worry about being seen in counselors’ halls and waiting rooms and about being judged and “found out.” They also worry about confidentiality. They believe that no matter what the organization, if it’s affiliated with the armed forces, it will keep records that could easily be shared with other branches and departments.

Non-military families may have similar feelings, but military families carry with them an extra dose of shame of being “found flawed.” They also say they “have had it” with the power of military and government rules. They long for privacy, and they have far higher doubts that their insurance can protect them.
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By Alyson Mischel, LCSW

Introduction

Historically, social workers are trained to work with the populations most in need of assistance. They practice in prisons, with drug users, the severely mentally ill, batterers and domestic violence victims, and with HIV positive clients. But, increasingly, social workers have private practices and treat people who can afford to pay for traditional 50 minute psychotherapy sessions. Regardless of the brand of social work practiced, or the population served, social workers can rely on concepts of media psychology to serve their clients.

Most everyone watches television, listens to the radio, or reads some form of printed press on a daily basis. Media is the 21st century’s glue – it’s what connects us and makes a Wall Street banker able to relate to a struggling waiter in Los Angeles. As a consumer who may communicate with a therapist online, or have a therapist use television and film as case studies, it’s important to understand the following basic concepts of media psychology and how they relate to psychotherapy.

Telemedicine

Telemedicine is the delivery of medical and/or psychological services at a distance with the use of technology like telephones or web-based systems. Treatment via telemedicine could involve two medical professionals talking over the telephone in real time about a case and also the use of satellite equipment allowing a doctor in California to evaluate, diagnose, and treat, a patient in Brazil.

The focus of telemedicine is largely consultative, which is why there is a growing trend toward online, synchronous psychotherapy. Some psychotherapists offer online and telephone counseling services for marriage, depression, parenting, family, and grief issues. The International Society for Mental Health Online,  the National Association of Social Workers and the American Psychological Association have issued statements about telephone counseling. Understanding how telemedicine works is essential for consumers since psychotherapists increasing use e-mail and the Internet to provide services.

Cinematherapy

Cinematherapy is the use of film as a metaphor to bring about positive growth in psychotherapy clients. Watching television and films may be a catalyst for healing and change. Movies can be “windows” to the unconscious in the same way that dreams and fantasies are. Watching films allows clients to become consciously aware, resulting in gained insight and emotional release. Cinematherapy works best in the tradition of Systems Theory and Cognitive Behavioral Therapy, which are the treatment modalities used by most social workers. Films may help clients become aware of their irrational beliefs and poor coping mechanisms. Cinematherapy is another tool like stories, myths, and fables, that psychotherapists use to treat their clients.

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To read more from Alyson Mischel visit www.alysonmischel.com

A positive, compassionate, and enthusiastic personality, Alyson Mischel brings a special brand of empathy to her psychotherapy and life coaching work. Alyson combines her education and clinical training with her own experiences, and has developed a common sense approach for addressing life’s challenges. Alyson is a lecturer at the USC School of Social Work, and serves as a consultant for UCLA’s Educational Leadership Program, a doctoral program of education. She was formerly a clinical supervisor for the Los Angeles County Department of Mental Health. Alyson has counseled hundreds of people in the areas of career, relationships, health, and finances. A graduate of Stanford University, the University of Southern California, and a licensed clinical social worker, Alyson has been studying and practicing since 1998.

Reviewed by NASW Office of Social Work Specialty Practice Staff

Introduction

Families plan and prepare for major life events: attending college, getting married, having a baby, and retiring at the end of a career. However, few plan for events such as how we would want our health care delivered if we become very ill.

Or some people may be adamant about not going into a nursing home but they fail to plan for securing long-term care insurance, home modifications, or having someone to advocate for them if they cannot communicate. Rarely do we think that far head.

These are decisions that we all should be thinking about. They should be documented so that our family members, health care providers, etc. will know our wishes for our care.

In generations past, people who were terminally ill remained at home, dying quickly from infectious diseases or accidents. Today, with the deluge of new medicines and technologies, we have become a “death denying” society, in which death is an enemy that must be beaten at all costs. We focus on fighting death rather than preparing for its inevitability.

Who Needs Advance Care Planning?

Every adult can benefit from Advance Care Planning.  Planning is particularly important for those who are terminally ill. Research shows that people suffering from chronic illness also benefit from advance care planning. Even healthy people should consider their wishes for end-of-life care and discuss their decisions with family members or professionals, before a health care crisis occurs.

Because an accident or serious illness can happen suddenly, and at any time, thinking about this topic when you are capable of making decisions is important. Sharing these decisions with your family helps to ease their burden and reduce their uncertainty if they ever have to make health care decisions on your behalf.

What Are the Benefits of Advance Care Planning?

Studies funded by the Agency for Healthcare Research and Quality (AHRQ) have shown that people who talked with their family, physician, or others about their preferences for end-of-life care had less fear and anxiety, felt more in control of their own medical care, and believed their doctor had a better understanding of their wishes. Other potential benefits of advance care planning according to the National Institutes of Health include:

• Decreased personal worry
• Decreased feelings of helplessness and guilt for the family
• Decreased implementation of costly, specialized medical interventions
• Decreased overall health care costs

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Ms. Linda Guhe, MSW, LCSW

The History of Tobacco and Health in America

Tobacco has been around since ancient times and it has been significant throughout American history. When Christopher Columbus discovered America in 1492 he also discovered smoking tobacco. Tobacco proved to be quite appealing to those early explorers. As a result, tobacco from America spread to other parts of the world. Tobacco was first grown commercially in America in the early 1600s. In the 1800s, the revenue from taxed tobacco helped finance the Civil War. In the early 1900s, RJ Reynolds began producing and selling the first brand-name cigarette, Camel.

While popular and appealing, tobacco use has led to serious health problems in the United States and world-wide. Today, approximately 25 percent of Americans smoke. Fifty percent of those who use tobacco will die from a smoking-related illness, approximately 450,000 people each year. The number of Americans using smokeless tobacco ranges from two percent to 9 percent. Financial costs of treating tobacco-related illnesses in the US are more than  50 billion dollars a year.

Health Care Providers and Tobacco Dependence

It may be surprising to learn that tobacco dependence is actually under-diagnosed by providers in the health care community. However, because of an increasing awareness in recent years of the physical dangers to health, along with financial burden for society, tobacco has been gaining more attention in public health education and research. For example, the federal government is focussing on the problem with its Healthy People 2010 initiative.  Among the government’s health objectives for the years 2000 through 2010 is a campaign to promote the cessation of tobacco use.

There are reasons why healthcare professionals have failed in the past to recognize, diagnose, and treat tobacco dependence. For one thing, until recently, the subject of tobacco dependence as a treatable disorder has been limited in the formal training of health care professionals. As a result, in comparison to experts in other kinds of disorders, there are only a small number of researchers and specialists who provide scientific information about the effects of tobacco use and effective methods of treatment.

Money became available to fund tobacco dependence research as a result of the financial settlement of lawsuits filed against the tobacco companies by 46 states in 1994 and 1995.  The lawsuits were filed in response to financial burdens experienced by states in treating tobacco-related illnesses. Money and publicity from the 1998 Master Settlement Agreement (MSA) made between tobacco companies and the states that filed the lawsuit has helped fund, draw interest to, and generate tobacco research.

Because of an increase in research in the last several years, we now have a better understanding of tobacco. We now know that tobacco products contain both (1) harmful toxins that damage health and (2) nicotine, which is a powerful addictive drug. Research has also led to the development of evidence-based methods of tobacco cessation treatments. As a result, the number of specialists in tobacco and the treatment of tobacco addiction have been increasing.

Tobacco researchers and specialists are now providing health care providers with the necessary tools and guidelines to talk with their patients about smoking, and for offering tobacco cessation treatment. In addition, there are multiple agencies providing information to the public on smoking and tobacco addiction, and help for quitting.

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Reprinted with permission of the organization People Living With Cancer

Introduction

For people diagnosed with cancer, an oncology social worker is an important member of the health-care team. An oncology social worker provides services, such as counseling, education, and information and referrals to community resources, including support groups. An oncology social worker often acts as a liaison between people with cancer and the medical team, and helps people find ways to navigate the health-care system. He or she works with the medical team to make sure people with cancer get the information they need to make informed choices about their care, and the support needed to manage the day-to-day challenges of living with cancer.

Taking Care of the Whole Person

An oncology social worker is a professional who has specialized training in how a diagnosis of cancer affects a person and his or her family and friends. An oncology social worker understands that there are many aspects of a person’s life outside of cancer, and that cancer affects each person in a different way. The oncology social worker’s expertise is a comprehensive view of the person living with cancer that is respectful of each individual’s ethnicity, spirituality, family situation, unique strengths and challenges, and it is his or her job to represent a person’s interests and needs to the medical team.

For most people, a cancer diagnosis brings with it new feelings and experiences. Talking to a professional who has helped other people manage similar situations may help a person find ways to improve quality of life, manage fears, and find hope. A social worker talks to people about the different aspects of adjusting to the cancer, and helps find strategies to adapt to, and manage health-care concerns. This can happen through individual, couples, and family counseling; support groups; and referrals to community agencies that have additional support programs.

A Bridge to the Medical Care Team

An oncology social worker has advanced training in cancer treatment, as well as in how treatments affect people living with cancer. Many people with cancer find that information that may have been easy to read and absorb in a textbook is much more difficult to understand when it pertains to their own health. A social worker helps gather the information people need to make decisions about their care. He or she may arrange a family meeting with the medical team, at which people’s care and treatment options may be discussed. A social worker can also refer people to additional educational resources and to community organizations that have information about cancer and treatment.

New Roles and Responsibilities

People may wonder how their parents, children, friends, and coworkers will react to their cancer, and how they will feel about that reaction. People may also wonder if there will be changes in their ability and desire to keep up with the many responsibilities of their life, such as a demanding job, taking care of young children, or helping an older parent. A social worker can arrange a meeting to talk about how those roles and responsibilities might change, and about what kind of support he or she wants and needs while going through treatment…Click here for the rest of this article

Army National Guard Specialist Chuck Ross

The Veteran’s Administration employs more than 4,400 MSWs to assist veterans and their families with individual and family counseling, patient education, end of life planning, substance abuse treatment, crisis intervention, and other services.

Please click here to read the article Leaving the War Half a World Away which is the story of Army National Guard Specialist Chuch Ross pictured above. When Mr. Ross returned home from the Iraq war experiencing symptoms of post traumatic stress disorder, he turned to social worker Dr. Rick Selig for help.

Below are links to additional articles about veterans affairs and social work.

• - About Post Traumatic Stress Disorder (PTSD) and Brain Injury in Iraq’s War Veterans
• - Help for Spouses of Combat Vets With Post Traumatic Stress Disorder From People Who Know
• - When the Soldier Doesn’t Return: The Needs of American Families of Down Warriors in Iraq
• - What It’s Like to Help Disabled Veterans as a Veterans Health Administration Social Worker
• - Love, Honor, & Obey: Working With Military Men and Their Families
• - How Social Workers Help Veterans and Their Families
• - Help for World War II POWs: The Former POW Living History Project
• - Retired Army Colonel and Dean of the University of Maryland, Baltimore School of Social Work, Jesse J. Harris, PhD, Honored by the Maryland Legislature

The Mental Health Self-Assessment Program (MHAP) is a voluntary, anonymous mental health and alcohol service members affected by deployment or mobiliation. Please click here to learn more.