Veterans

Social workers are an integral part of the interdisciplinary treatment teams within every Veterans Affairs (VA) Medical Center, Vet Center, and in many VA Community Based Outpatient Clinics. VA social workers work “to eliminate psychosocial complications as significant barriers to healthcare interventions for veterans and families. This is accomplished by developing and maintaining integrated, quality programs in patient care, research, education and prevention.” (http://www.socialwork.va.gov/) They play a pivotal role in easing the transition of the men and women who have served in our Nation’s military to veteran status and are actively involved in assisting in seamless transition efforts for veterans of Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF).

This research Web page provides links to the Veterans Affairs network and highlights the broad spectrum of social work research wherein veterans are the study population. The research shows the wide range of practice knowledge-building that has resulted from social work’s engagement with veterans.  From World Wars through regional conflicts, from armed forces and National Guard members, from those identified as heroes upon their return home, and from those who have faced societal scorn for their involvement in unpopular conflicts has grown a body of evidence affirming the social work perspective of the person-environment influence in building mental, physical, and psychosocial well-being.  The primary veterans’ service provider and supporter of related research is the Department of Veterans Affairs (VA), established as an independent agency under the President by Executive Order 5398 on July 21, 1930, and elevated to Cabinet level on March 15, 1989 (Public Law No. 100-527). The first social work services were established in 1926 and predate the official establishment of the Department.  The Department’s mission is to serve veterans, their families and their caregivers. According to the VA Web site,

Of the 25 million veterans currently alive, nearly three of every four served during a war or an official period of hostility. About a quarter of the nation’s population—approximately 70 million people—are potentially eligible for VA benefits and services because they are veterans, family members or survivors of veterans.
(Retrieved from http://www.va.gov/about_va/ on 12/8/05.)

As the largest employer of social workers, VA employs more than  4,000 master’s-level social workers, and is also a major supporter of social work training programs with over 100 field sites and more than 600 social work graduate students trained annually.  The VA social work program Web site provides the history of VA social work services, describes the breadth of services, and provides links to the VA Social Work organization, their newsletter, and mission statement. See http://www.socialwork.va.gov/

The VA is also committed to research on veteran-related services and intervention models, including Post Traumatic Stress Disorder (PTSD) treatment, resilience-building, recovery from alcohol and drug abuse, as well as integrating family-related and care-giver services during the often extensive recovery periods involved with physical rehabilitation. Veterans services address issues relating to adolescence through senior care. Thus, veteran-related social work services and research have impact on a range of bio-psychosocial services of relevance throughout the service spectrum and lifespan.

In fiscal year 2004, spending on research related to aging conducted by VA investigators totaled $80.2 million for 472 funded research projects.  Of this research, 143 projects received VA research funding, 320 projects were funded from other sources, such as the National Institutes of Health, and nine projects were funded by VA as well as other sources.  The VA Geriatric Research, Education and Clinical Center (GRECC) program was established in 1975 to increase basic knowledge of the aging process, share that knowledge with other health care providers, and improve the overall quality of care for elderly veterans.  Their research includes biomedical, applied clinical, health services, and rehabilitation research. For more information on GRECC research, see http://www1.va.gov/opa/fact/gersrch.html

Selected Social Work Research References

The following abstracts were selected from veteran’s research studies that appear in Social Work Abstracts.  They include a wide range of research focus, from disability particular to military service to needs pertinent to the general public. Studies of caregivers, studies related to workforce issues, and studies relevant to both treatment and policy are included.

Gender differences in the rehospitalization of substance abusers among homeless military veterans.
Benda-B-B. Journal of Drug Issues. 34(4): 723-750, Fall 2004.

This two-year follow-up study of military veterans treated in an inpatient drug treatment program was designed to examine any gender differences in predictors of rehospitalization for substance abuse or other psychiatric disorders. A survey was administered to 310 women and 315 men, involving several ecological predictors that rarely if ever had been investigated. For example, Cox’s proportional hazard model indicated that childhood and current sexual and physical abuses were stronger predictors among women, whereas degree of substance abuse, cognitive disorders, aggression, and disadvantageous peer associations were stronger predictors among men. Social service implications of those findings were presented. (Journal abstract)

Developing programs for homeless veterans: Understanding driving forces in implementation.
Nakashima-J; McGuire-J; Berman-S; Daniels-W. Social Work in Health Care. 40(2): 1-12, 2004.

Between 1992 and 2003, services for homeless veterans at the Veterans Affairs Greater Los Angeles Healthcare System went from inappropriate utilization of hospital medical and psychiatric beds, to a continuum of residential treatment, transitional housing, and employment programs through arrangements with private agencies. The authors use elements of Hasenfeld and Brock’s Political Economy Model (1991) to explain this transformation in service delivery that was spearheaded by a VA social work leadership team. It is argued that three driving forces crucial to program implementation were present: technological certainty, economic stability, and concentration of power. Evidence of the implementation’s impact includes creation of new homeless program beds, a reduction in use of medical/psychiatric beds, and a large number of formerly homeless veterans with housing and employment at program discharge. Study limitations and implications for future studies are discussed. (Journal abstract)

Does PTSD differ according to gender among military veterans?
Benda-B-B; House-H-A. Journal of Family Social Work. 7(1): 15-34, 2003.

This was a study involving systematic random samples of 225 male and 232 female military veterans respectively that had received services at a VAMC in the South. The purpose was to examine what ecological factors predict a diagnosis of posttraumatic stress disorder (PTSD) among those veterans. As expected, gender differences in relevant predictors of PTSD were observed: Generally interpersonal factors, depression, and fearfulness were more important to PTSD among women. Among men, self-efficacy, resilience, suicidal thoughts, alcohol and other drug abuse, and combat stress were more relevant. However, physical and non-physical abuses in the family-of-origin were significantly related to PTSD for both women and men, albeit those abuses were more important for female veterans. Conceptual and family social work implications of the study are discussed. (Journal abstract)

Homeless alcohol/other drug abusers: Discriminators of non-offenders, nuisance offenders, and felony offenders.
Benda-B-B; Rodell-D-E; Rodell-L. Alcoholism Treatment Quarterly. 21(3): 59-80, 2003.

This was a study of crime among 188 homeless persons who were in a Veterans’ Affairs Medical Center program for homeless alcohol and other drug abusers. The purpose of the study was to find out: (a) what proportion of these homeless veterans committed felonies, and (b) what factors discriminate between non-offenders, nuisance offenders, and felony offenders. Data indicated 27 percent committed nuisance offenses, and 41 percent had committed felonies in the past year. Personal strengths and accomplishments discriminate between non-offenders and offenders. Self -esteem and social relations and support discriminate between felony offenders and other homeless people. Treatment implications of these findings are discussed. (Journal abstract)

Test of a structural equation model of comorbidity among homeless and domiciled military veterans.
Benda-B-B. Journal of Social Service Research. 29(1): 1-35, 2002.

This exploratory study of 600 Vietnam era military veterans was designed to test a hypothesized theoretical model of comorbidity (substance abuse and depression) among domiciled and homeless persons. The model tested represented an integration of stress process and social support models found in the literature on substance abuse and on depression. Caregiver attachment and early abuse also were used to elaborate on the integrated stress-social support theoretical model. Using structural equation modeling, all relationships in the hypothesized model were supported by data from domiciled veterans, except attachments to caregivers were not related to peer associations with substance users, and these associations were not related to depression. In contrast, all 24 relationships hypothesized in the model tested were supported among homeless veterans. Conceptual and practice implications of the findings are discussed. (Journal abstract)

Relative contribution of familial factors to comorbidity among homeless veterans.
Benda-B-B; Rodell-D-E; Rodell-L. Journal of Family Social Work. 6(2): 3-24, 2001.

This is a study of a random sample of 188 homeless veterans, aged 26 to 59, who abuse substances, many of whom are comorbid with depression. All of these veterans are inpatients in a program for substance abuse in a Veterans’ Administration Center in the South. The foci of the study are the relative effects of familial factors on comorbidity among homeless military veterans (comorbidity is defined in this study as substance abuse with depression). Familial substance abuse, psychiatric afflictions, physical abuse, and relational problems were among the strongest predictors of comorbidity among veterans. Other top predictors were direct combat experience in war, number of times treated for substance abuse, years of alcohol abuse, and resilience. In fact, direct combat experience was the strongest predictor. Family social work implications were discussed. (Journal abstract)

Gender awareness among Veterans Administration health-care workers: Existing strengths and areas for improvement.
Vogt-D-S; Stone-E-R; Salgado-D-M; King-L-A; King-D-W; Savarese-V-W.   Women and Health. 34(4): 65-83, 2001.

In response to the growing number of women within the Veterans Health Administration (VHA), along with the challenge of meeting their health  care needs in a historically male-focused setting, VHA has supported a variety of research projects aimed at evaluating and improving the status of women’s health and health care experiences. While these efforts have primarily focused on aspects of care such as the availability and accessibility of services and the provision of timely care, this study focused on the contribution of interpersonal aspects of care. Specifically, staff gender awareness, conceptualized as health care workers’ gender-role ideology or attitudes, gender sensitivity, and knowledge was examined. Findings revealed both strengths and weaknesses in domains of staff gender awareness and significant relationships between staff demographics and gender awareness components. (Journal abstract)

Progressive dementia: Personal and relational impact on caregiving wives.
Bauer-M-J; Maddox-M-K; Kirk-L-N; Burns-T; Kuskowski-M-A. American Journal of Alzheimer’s Disease and Other Dementias. 16(6): 329 -334. Nov.-Dec. 2001.

The purpose of this exploratory study was to examine the perceptions of 115 female spouse caregivers of early to moderate stage dementia patients. Based on patients’ cognitive status, cross-sectional comparisons of two groups of caregiving wives were conducted. No group differences were found in measures of caregiver burden, depression, or personal gain. However, wives of patients with greater cognitive impairment experienced lower levels of mastery and more relational deprivation when compared to wives of patients with higher mental status. Supportive approaches might be directed toward helping early dementia caregivers restructure their understanding of, and participation in, their marital relationships in anticipation of changes ahead. Interventions aimed at enhancing a caregiver’s sense of personal mastery may help reduce the negative effects of dementia on caregivers’ well-being. (Journal abstract)

The older driver with Parkinson’s disease.
Adler-G; Rottunda-S; Bauer-M; Kuskowski-M. Journal of Gerontological Social Work. 34(2): 39-49, 2000.

This study surveyed older drivers with Parkinson’s disease (PD) and a control group for the purpose of obtaining information about driving history, habits, and expectations about driving cessation. Compared to control subjects, PD drivers were more likely to have reduced their driving over the past five years (p = 0.002). In addition, PD drivers had significantly more crashes (p = 0.003). Not surprisingly, families of PD drivers expressed greater concern about patient driving (p = 0.0001). Because of the complexities of the issue of driving and PD, social workers have the responsibility to provide emotional and practical supports to their PD clients and family members. (Journal abstract)

Predictors of rehospitalization of military veterans who abuse substances.
Benda-B-B. Social Work Research. 25(4): 199-212, Dec. 2001.

The study reported in this article is of a systematic random sample of 600 homeless Vietnam veterans, ages 46 to 65, who abuse substances, and many of whom are comorbid with psychological afflictions. All of these veterans were in a Midwestern residential program for homeless substance abusers at the time of the interview. Cox’s proportional-hazards model was used to estimate the relative rate of rehospitalization (hazard function) across the follow-up interval of two years by the predictors. The ecological predictors include, but are not limited to, demographic characteristics, history of drug and psychiatric treatment, psychological afflictions, abuse before 18 years of age, inner strengths, social support, religiosity, and direct combat experience in Vietnam. The range of ecological factors investigated presents more comprehensive findings for future conceptual models and for more thorough social work intervention. (Journal abstract)

Head injury as a predictor of psychological outcome in combat veterans.
Vasterling-J-J; Constans-J-I; Hanna-Pladdy-B. Journal of Traumatic Stress. 13(3): 441-451, July 2000.

Although it is recognized that psychosocial variables influence the expression of psychopathology following trauma exposure, physiological variables have received less attention as potential mediators of psychological outcome in trauma victims. The purpose of this study was to examine the relationship of head injury to psychological outcome in 171 combat veterans seeking compensation for service-connected disabilities for mental disorders attributed to etiologies other than head injury. Veterans underwent a structured psychiatric diagnostic interview and completed self-report measures of combat exposure, posttraumatic stress disorder (PTSD), depression, and occurrence of head injury. Comparisons between veterans with and without history of head injury indicated that head injury was associated with more severe depression. Regression analysis suggested that head injury predicted depression, but not PTSD, severity. (Journal abstract)

Understanding social workers’ sense of competence within the context of organizational change.
Kayser-K; Walker-D; Demaio-J. Administration in Social Work. 24(4): 1-20, 2000.

As large health care systems rapidly evolve, social work administrators struggle to help practitioners maintain a sense of competence during a state of flux and uncertainty. Using a sample of social workers from seven veterans hospitals and one state hospital, this study investigated the relationship of job and worker characteristics, change schema, and organizational change to workers’ perceived competence. Workers with more practice experience, fewer distracting outside responsibilities, and higher levels of job satisfaction had a higher sense of competence. Positive change schema and positive perceptions of organizational climate were also significant predictors of competence. Organizational climate had a partial mediating effect on the relationship between social workers’ change schema and their sense of competence. The findings have implications for social services administrators who are seeking to promote competence among practitioners within the context of organizational change. (Journal abstract)

Existential psychotherapy with Vietnam veteran couples: A twenty-five year report.
Lantz-J; Gregoire-T. Contemporary Family Therapy. 22(1): 19-37, Mar. 2000.

Existential psychotherapy with Vietnam combat veteran couples should include treatment elements of holding, telling, mastering, and honoring the combat trauma pain. The authors describe these four treatment elements and provide a descriptive clinical study of this treatment approach with 53 Vietnam veteran couples treated by the first author between 1974 and 1999. All 53 couples made good progress during treatment, as indicated by self-reports and two clinical measures of marital adjustment. (Journal abstract)

A descriptive study of children born to Vietnam veterans diagnosed with PTSD.
Gratton-R-T. Smith College, PhD, August 1998.

This study assessed children born to Vietnam War veterans diagnosed with war-related Posttraumatic Stress Disorder (PTSD) to learn whether the extent and type of involvement children have with their PTSD fathers predict behavioral competence. The study is a secondary analysis focusing on 55 children (27 males and 28 females) ranging in age from 5 to 16 years. Children’s behavioral competence and degree of involvement with their fathers were compared with their father’s PTSD symptom picture. Based upon prior research of adult children born to PTSD fathers from World War II, the study hypothesized that children’s characteristics and their family constellations would determine involvement with their fathers and would predict behavioral competence. The results supported only the family size hypothesis. The greater the number of siblings, the greater the number of problems among them as reported by the teacher. Supplemental data analysis suggested that socioeconomic status predicts behavioral competence. (Journal abstract)

Attitudes toward service use among wife caregivers of frail older veterans.
Dorfman-L-T; Berlin-K-L; Holmes-C-A. Social Work in Health Care. 27(4): 39-64, 1998.

This study investigated (1) attitudes toward service use among wife caregivers of frail older veterans; and (2) the relationship between those attitudes and service utilization by the wives. The study focused on three sets of attitudinal variables: attitudes towards various kinds of dependencies; individual and family ethos concerning service use; and perceptions of responsibility for care. Respondents were 80 wife caregivers of frail older (age 55+) veterans at a Department of Veterans Affairs Medical Center in a Midwestern state. Most caregivers agreed that it is acceptable to get help with the physical care of the husband and to get help themselves for the emotional strains caused by caregiving. Acceptability of a wife’s getting help with the physical care of her husband was a positive predictor of number of services ever used and frequency of in-home service use. Wives’ view that help from outside agencies should be used only as a last resort was the strongest and most consistent negative predictor of both number of services ever used and frequency of service use. (Journal abstract)

Triage services: A profile of high utilization.
Berg-Weger-M; Gockel-J; Rubio-D-M; Douglas-R. Social Work in Health Care. 27(1): 15-31, 1998.

With challenges continuing to be presented to health care delivery, inappropriate outpatient service utilization is of utmost concern to all health care service providers. This study is an examination of the utilization patterns of 189 veterans in an urban Veterans Administration Medical Center (VAMC). Factors found to be related to high utilization of ambulatory care triage clinic services for veterans who had presented for at least two unscheduled visits in the past six months include patient perception of health status, number of prescription medications, and social needs. Implications for social work practice, program development, and research are discussed. (Journal abstract)

Using second-order factor analysis in examining multiple problems of clients.
Pike-C-K; Hudson-W-W; Murphy-D-L; McCuan-E-R. Research on Social Work Practice. 8(2): 200-11, Mar. 1998.

Data from veterans of the Persian Gulf engagement were studied to assess the potential of second-order factor analysis in examining, interpreting, and directing person-environment interventions with an array of different but related individual and environmental problems. Participants of the study were 1,532 veterans of the Persian Gulf engagement who were eligible for social services provided by the Veterans Administration. The results provided support for the use of second-order factors in examining client data and provided information about the relationships among clinically significant problems. Further research on the second-order factors of multidimensional instruments that are used in social work to measure client progress can yield information about how client populations differ and provide direction in selecting interventions that are congruent with social work’s person-environment focus. (Journal abstract)

The role of grief in the delayed reaction of Vietnam veterans.
Prevost-M. Tulane Univ., DSW, Dec. 1996.

This exploratory study, completed in 1996, of 34 Vietnam veteran voluntary respondents was conducted to explore the strength of association between Posttraumatic Stress Disorder (PTSD) and nine specific components of grief. Comparisons were made of the resulting global scores on the Mississippi Scale for Combat-Related PTSD and the scores from each scale of the Grief Experience Inventory (GEI). The nine scales or specific grief components are: Despair, Anger, Guilt, Social Isolation, Loss of Control, Rumination, Depersonalization, Somatization, and Death Anxiety. A nonparametric statistic, the Spearman rank correlation coefficient was used to analyze the comparative rankings of scores. Results suggest that each of the nine comparisons was positively related and significant at the .05 level. Rankings of scores for Despair, Somatization, and Anger/Hostility were the variables indicating the highest agreement with rankings of PTSD scores. The research builds on interactive models of PTSD etiology and contributes to the quantitative exploration of the correlation between the components of grief and PTSD still being manifested. The findings support the stage of grief resolution as an important consideration for assessment and treatment of PTSD. (Journal abstract)

Multidisciplinary team treatment of a Vietnam veteran with post-traumatic stress disorder.
Dixon-D-R; Thyer-B-A. Social Work and Social Sciences Review. 6(3): 163-174, 1997.

A Vietnam veteran with posttraumatic stress disorder (PTSD) will usually seek treatment in an outpatient clinic, a general psychiatric ward, a specialized inpatient PTSD unit (SIPU), or with a PTSD clinical team (PCT). These four treatment locations are described briefly. The veteran in this case study chose a general psychiatric ward for several reasons, all of which are discussed in this paper. Posttraumatic stress disorder is defined, and the impact of PTSD on families is described. The remainder of the paper consists of details regarding composition and operation of the multidisciplinary treatment team which provided treatment for this veteran. (Journal abstract)

Homeless veterans: Perspectives on social services use.
Applewhite-S-L. Social Work. 42(1): 19-30, Jan. 1997.

This study analyzes the nature and scope of homelessness and issues related to social services use. Using focus group interviews, this exploratory study examined the expressed needs of homeless veterans and the obstacles encountered in obtaining health and human services. Types of problems and social services barriers were developed with exemplars from the interviews. These veterans self-reported a high incidence of health and mental health problems, limited resources, negative public perceptions and treatment, insensitive service providers, dehumanizing policies and procedures, and high levels of stress and frustration with the service delivery system. They encountered personal, situational, and bureaucratic barriers to obtaining services and were highly critical of service providers. These findings suggest a need for greater emphasis on advocacy -based case management services, affordable housing, employment opportunities, increased sensitivity in service delivery systems, and empowerment-centered practice. (Journal abstract)

Alcohol treatment: Measurement of effectiveness by global outcome.
Thevos-A-K; Brown-J-M; Malcolm-R; Randall-C-L. Social Work in Health Care. 23(3): 57-71, 1996.

Traditional methods of data analysis in alcohol studies focus only on alcohol consumption as dependent variables rather than considering a global, person-in-environment perspective. The purpose of this study was to evaluate treatment outcome in a clinical trial using dimensions of life functioning in addition to quantity-frequency measures of alcohol use. Subjects were male veterans suffering from high levels of anxiety in addition to alcohol dependence who were randomly assigned to treatment with a placebo or buspirone. Results show that global outcome measures did not reveal differences from standard treatment outcome measures in this study. All of those subjects who were drinking heavily, and most of those drinking moderately, were experiencing life problems. However, studies with other designs and with larger sample sizes are needed. (Journal abstract)

Wife caregivers of frail elderly veterans: Correlates of caregiver satisfaction and caregiver strain.
Dorfman-L-T; Holmes-C-A; Berlin-K-L. Family Relations. 45(1): 46-55, Jan. 1996.

This study investigated correlates of satisfaction and strain in 80 wife caregivers of frail elderly veterans. The study focused on the background and context of stress, stressors, and cognitive appraisal of self-efficacy and social/institutional support. Support from spouse was the strongest positive predictor of satisfaction with caregiving and the strongest negative predictor of caregiver strain. Confidence in ability to manage caregiving tasks (self-efficacy) was the strongest positive predictor of caregiver life satisfaction. (Journal abstract)

Screening for social and environmental problems in a VA primary care setting.
Cook-C-A-L; Freedman-J-A; Freedman-L-D; Arick-R-K; Miller-M-E. Health and Social Work. 21(1): 41-47, Feb. 1996.

Social workers are in an ideal position to identify and treat social and environmental problems early in the continuum of care. Information on these problems will facilitate informed decision making on the development and reallocation of resources to better meet patient needs. This study assessed the social and environmental problems of 132 patients seen in a primary care clinic at a university-affiliated Veterans Affairs (VA) medical center. The most prevalent social problems were financial difficulties, personal stress, family problems, legal concerns, and employment concerns. When asked, nearly one-third of all respondents requested social work services or information about services related to their problems. The findings suggest a clear need for social work interventions in VA primary care clinics that focus on both psychosocial problems. (Journal abstract)

Psychosocial outcomes of HIV illness in male and female African American clients.
Linn-J-G; Poku-K-A; Cain-V-A; Holzapfel-K-M; Crawford-D-F. Social Work in Health Care. 21(3): 43-60, 1995.

With the rapid growth of HIV infection among African Americans, the issue of how medical problems relate to psychological functioning in the black community population has acquired new meaning and urgency for health care policy. To develop effective strategies to meet the mental health needs of infected African Americans, a better understanding is needed of the pattern of association between HIV and psychological distress. The objective of this study is to test several hypotheses that predict depression and anxiety in black adults infected with HIV. (Journal abstract, edited)

Clinical practice and heuristic reasoning.
Murdach-A-D. Social-Work. 40(6): 752-58, Nov. 1995.

Increasingly, commentators have noted that along with formal clinical decision-making methods, practitioners also use a variety of informal decision strategies to expedite their work. These types of heuristics have recently received attention in a number of theoretical studies of clinical decision making. This study reviews some of these studies and applies their findings to the results of in vivo research on clinical decision processes carried out by the author on a psychiatric ward in a large medical center. This research corroborated many of the theoretical formulations developed in earlier studies. However, some significant differences were also discovered between research based principally on theory and research derived from experience under the conditions of daily practice. (Journal abstract)

Women after war: Vietnam experiences and post-traumatic stress: Contributions to social adjustment problems of Red Cross workers and military nurses.
Salvatore-M. Simmons College, PhD, May 1992.

A descriptive study examined the Vietnam experiences, posttraumatic stress disorder (PTSD) symptoms, and later social adjustment of 102 military nurses and 233 Red Cross workers (N = 335). The association of Vietnam experiences to PTSD symptoms and PTSD symptoms to later social adjustment were investigated. Measures for experiences and symptoms were author designed. A social adjustment scale and depressive symptoms scale were included. Denial of emotion, sexual harassment, inadequate preparation for the war zone, and feeling responsible for another’s death were associated with PTSD symptoms. Overall, relationships disrupted by loss provided the strongest associations to PTSD. PTSD symptoms were associated with social adjustment problems with sexual partners, children, family members, friends, and at work. Needed program and policy changes applicable to the American Red Cross, Veterans Administration, and Armed Forces were discussed. Provision of care for civilian volunteers with war-related problems was recommended. (Journal abstract)

Commitment to social change: Voices from the feminist movement.
Hyde-C-H. Journal of Community Practice. 1(2): 45-64, 1994.

The purpose of this study was to examine commitment as it relates to the pursuit of social change. This examination is done through the analysis of veterans’ accounts of their involvement in feminist social movement organizations (FSMOs). The veterans convey their stories of commitment to the feminist movement with language that one might use to describe an intimate relationship. The collective voice suggests considerable sacrifice and dedication. The study also reveals a deep belief that study subjects were betrayed by movement beneficiaries. This sense of betrayal is rooted in the expectation that movement commitment would increase as attacks by the New Right on the FSMOs rose. The study concludes with discussion on the relevancy of studying commitment to social change for both micro and macro social work theory and practice. (Journal abstract)

Effect of pre-discharge interventions on aftercare attendance: Process and outcome.
Sharma-S-B; Elkins-D; van Sickle-A; Roberts-C-S. Health and Social Work. 20(1): 15-20, Feb. 1995.

A widely recognized problem in the mental health services delivery system is that of patients’ early discontinuance of therapy. But less attention has been given to the high rate of nonattendance at initial appointments in outpatient mental health settings. The purpose of this study was to determine if particular pre-discharge interventions had an effect on whether psychiatric patients attended their initial aftercare appointments at a Veterans Administration mental health clinic. Two groups of patients were given pre-discharge interventions and one was not (a control group). Results showed a trend of greater attendance at initial aftercare appointments by those who received a pre-discharge intervention; however, the differences were not statistically significant. Suggestions for clinicians and researchers are provided. (Journal abstract)

An assessment of practitioner cross-racial treatment experiences.
Davis-L-E; Gelsomino-J. Social Work. 39(1): 116-23, Jan. 1994.

This study sought to determine differences in the cross-racial practice experiences of white and minority social services practitioners. Fifty -three counselors in a Veterans Administration outreach center evaluated various aspects of their cross-racial practice experiences. Both white and minority counselors perceived themselves to work equally well with white clients, but white counselors perceived themselves to be less effective when working with minority clients. The majority of white and minority counselors reported identifying the source of white clients’ problems as being external. This finding was interpreted as being a possible bias against white clients on the part of both white and minority practitioners. White counselors reported experiencing less client credibility, and minority counselors reported more incidents of racism. Implications for social work are discussed. (Journal abstract)

Asian-Pacific American Vietnam veterans: An exploratory study of war-time experiences and post-war adjustment.
Matsuoka-J; Hamada-R; Kilauano-W; Coalson-R. Journal of Multicultural Social Work. 2(4): 103-11, 1992.

The literature on Vietnam combat veterans suggests that ethnicity is a key variable in influencing the perceptions of the war and post-war adjustment. Because they bore a physical resemblance to the Vietnamese, Asian-Pacific American (A-PA) veterans may have faced unique psychosocial conflicts. The authors gathered data on war-time and post-war experiences for 44 A-PA veterans from Hawaii. The results indicated qualitatively different experiences for A-PA veterans in Vietnam including a strong identification with the Vietnamese and estrangement from their white comrades in arms. Mississippi Scale scores indicated that rates of posttraumatic stress disorder for A-PA veterans were about the same as those reported for white vets in earlier studies, but ethnic subgroups of A-PA veterans earned substantially higher scores than whites. (Journal abstract, edited)

High social risk screening mechanisms: Patient characteristics as predictors of social work utilization in the VA.
Cook-C-A-L; Chadiha-L; Schmidt-B; Holloway-J; Satterwhite-J-L. Social Work in Health Care. 16(4): 101-17, 1992.

To facilitate timely access to social services in hospitals, high social risk screening mechanisms have been implemented throughout the United States. The purpose of these mechanisms is to identify patients upon admission who are most likely to need service. Because these screening mechanisms often identify patients who do not need service, this study determined how well the patient characteristics used as screening factors actually predicted service utilization. A multivariate logistic regression model was developed using 1,659 discharges from two Midwestern Veterans Administration hospitals. The most powerful predictors of social service use were age, multisystem illness, not having a spouse, and psychiatric comorbidity. Despite the significant contribution of each predictor, their combined ability to predict who receives service was modest. (Journal abstract, edited)

Research in social work practice: Benefits of and obstacles to implementation in the Department of Veterans Affairs.
Cook-C-A-L; Freedman-J-A; Evans-R-L; Rodell-D; Taylor-R-M. Health and Social Work. 17(3): 214-22, Aug. 1992.

Although research is an important part of social work practice in health care, there is little systematic information that sheds light on research productivity, the benefits of conducting research, or the obstacles that must be overcome. This article represents the viewpoints of nearly all the directors of social services departments in the largest multihospital system in the United States, the Department of Veterans Affairs. The organizational characteristics of hospitals and the attitudes of the directors about research were important correlates of research productivity. Although lack of time, resources, and interest were cited as common obstacles, more than one-third of the departments were conducting or involved in at least one study. Information about the research efforts of other social services departments was considered an important resource, particularly for departments with no ongoing studies. The implications of these findings for social work research in health care are discussed. (Journal abstract)

A retrospective evaluation of factors influencing successful outcomes on an inpatient psychiatric crisis unit.
Anthony-D-J. Research on Social Work Practice. 2(1): 56-64, Jan. 1992.

This retrospective chart review conducted by a Veterans Administration Medical Center social worker examined 69 records from inpatients receiving services at a short-term crisis intervention unit (CIU) between July 1985 and March 1986. The purpose of this study was to examine the characteristics of CIU patients successfully discharged to the community (n = 41) versus those requiring a transfer to a long-term care unit (n = 28). Treatment compliance and family support were found to be significant factors associated with successful program completion. (Journal abstract)

Caregivers’ views of disability allowances as a support for in-home care.
Adamek-M-E. Journal of Gerontological Social Work. 17(1/2): 121-137, 1991.

Recognition of the importance of families in providing care to older persons has led to advocacy for a variety of supports to assist them. This study examined caregivers’ (N = 155) views of economic support in the form of Veterans’ Administration Aid & Attendance allowances as a support for care at home. Few evaluative studies of economic support programs have directly questioned caregivers about their assessment of the helpfulness of the support alternative. Contrary to the findings of attitudinal studies, results here indicate that most caregivers found economic assistance to be helpful in supporting in-home care. Caregivers who had low levels of emotional and financial strain and who knew more about the benefit program were more likely to report that economic assistance was helpful. Higher benefit levels and spending on health-supportive items were also associated with a perception of helpfulness. (Journal abstract)

The relationship of social support to posttraumatic stress disorder among Hispanic and white Vietnam combat veterans.
Martinez-G-R. Catholic Univ. of America, DSW Dissertation, May 1990.

An ex post facto study investigated the relationship between self-perceived social support, exposure to combat, ethnicity, and posttraumatic stress disorder (PTSD). Also examined was the impact of social support on PTSD among Vietnam veterans from two different ethnic groups, Hispanic and white. The study surveyed a random sample of 180 Hispanic and white Vietnam-era veterans seeking services in six different veterans’ agencies during a two-month period. Subjects completed four instruments on social support, PTSD, and combat exposure; the data were analyzed by multiple regression analysis. The study affirmed the impacts of combat exposure and social support on the development of the negative readjustment symptoms of PTSD. For both ethnic groups, combat exposure was positively associated with PTSD, while increased contact and intimacy with friends and relatives was negatively associated with PTSD. The impact of both emotional and tangible crisis support on PTSD was found to be greater among white veterans. (Journal abstract)

Developmental impact of combat exposure: Comparison of adolescent and adult Vietnam veterans.
Harmless-A. Smith College Studies in Social Work. 60(2): 185-95, Mar. 1990.

A study was undertaken to find whether differences existed between two age groups of Vietnam veterans with posttraumatic stress disorder in terms of their social readjustment. A group of 57 men were divided into two age ranges to reflect two distinct periods of identity formation–adolescence and early adulthood. The social readjustment measures that were examined included: (1) substance abuse history; (2) history of legal infractions; (3) work history; (4) interpersonal relationships; and (5) peer relationships. It was found that the younger soldiers have had a more difficult post-Vietnam readjustment than their older cohorts. The results lend support to the idea that unsuccessful completion of Erikson’s developmental phase of identity versus role confusion may create problems with one’s capacity for love, work, and relationships. Specifically, when developmental tasks of late adolescence are not completed because of events such as war, one may suffer difficulties in handling adult responsibilities later in life. (Journal abstract, edited)

Timing of social work intervention and medical patients’ length of hospital stay.
Evans-R-L; Hendricks-R-D; Lawrence-Umlauf-K-V; Bishop-D-S. Health and Social Work. 14(4): 277-82, Nov. 1989.

Findings report that hospital inpatients who receive social work intervention present difficult problems and have longer-than-average lengths of stay and that the earlier in the hospitalization that intervention occurs, the shorter the stay will be. A total of 243 patients referred for social services at a 440-bed teaching hospital were evaluated. Paired t tests indicated a significant difference in the mean length of stay, based on normative data. Timing of the intervention accounted for a significant amount of variance (13 percent) in length of hospital stay. The major clinical implications of the study are that social work intervention has the potential to decrease length of hospitalization and that this research methodology may be used reliably to evaluate changes in discharge planning protocol. (Journal abstract, edited)

Performance standards for social workers.
Harkness-L; Mulinski-P. Social Work. 33(4): 339-44, July/Aug. 1988.

In 1981, the federal government issued a mandate for Veterans Administration (VA) medical centers to develop concrete measures of work performance for professional and nonprofessional staff. A study was designed to assess social workers’ understanding of performance standards and the degree to which the social workers felt the standards were relevant to their functioning in VA medical centers. Four topic areas—agreement   with the purpose of performance standards, agreement with the use of performance standards, agreement that performance standards are relevant to the social worker, and suggestions for alternative modes of performance evaluation—were incorporated into a 30-item questionnaire distributed to staff workers, supervisors, and administrators in the social work service departments of six VA medical centers in the Northeast. Questionnaires were returned by 67 staff workers and 11 supervisors and administrators. The results revealed that both supervisors and staff believed that ultimately the use of performance standards could benefit agency functioning, and both groups agreed with the administrative purpose of the standards. Neither group viewed performance standards as a means of career advancement in VA medical centers. The findings suggest that performance standards will be supported by staff provided that collaboration and communication occurs between staff workers and supervisors. (Journal abstract)

Posttraumatic stresses on women partners of Vietnam veterans.
Maloney-L-J. Smith College Studies in Social Work. 58(2): 122-43, Mar. 1988.

A study explored the hypothesis that the Vietnam War inflicted severe psychic wounding not only on veterans with diagnoses of posttraumatic stress disorder (PTSD), but on their women partners as well. In order to learn more about the lives of wives of veterans diagnosed with PTSD, open -ended semistructured interviews were held with a small sample of such women. The women were asked not only about their current and past experiences in their nuclear family, but also about their own as well as their partners’ families of origin. A number of issues emerged from these interviews. It was discovered that the women had had conflicted relationships with their mothers and idealized relationships with their fathers, that they considered their children as most important to them, that they saw themselves as mothers to their husbands, and that both nuclear and origin families presented strong patterns of alcohol and physical abuse. The findings helped to explain why these women remain in such difficult relationships and suggested the need for various kinds of therapeutic outreach to ameliorate the effects of Vietnam on these women and their families. (Introduction, edited)

A patient dies–a social worker reviews his work.
Pilsecker-C. Social Work in Health Care. 13(2): 35-45, 1987.
A case study describes the work of a hospital social worker with patient dying of cancer who spent the last six months of his life in the hospital. The study describes the challenges and frustrations of working with this terminal patient who, while initially relatively healthy and lucid, finally became extremely weak and often disoriented. (Journal abstract, edited)

May 18th, 2005 at 10:58 am

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