Personal autonomy in discharge planning decision -making in mentally alert hospitalized elderly individuals: The social workers' perspective

This study was conducted to understand (a) hospital social workers' perspectives about patients' personal autonomy and self-determination, (b) their experiences, and (c) their beliefs and behaviors. The study used the maximum variation sampling strategy to select hospitals and hospital social work respondents. Individual interviews were conducted with 31 medical/surgical and mental health hospital social workers who worked in 13 hospitals. The data suggest the following four points. First, the hospital setting as an outside influence as it relates to illness and safety, and its four categories, mentally alert patients, family members, health care professionals, and social work respondents, seems to enhance or diminish patients' autonomy in discharge planning decision making. Second, respondents report they believe patients must be safe both inside and outside the hospital. In theory, respondents support autonomy and self-determination, respect patients' wishes, and believe patients are the decision makers. However, in practice, respondents respect autonomy and self-determination to a point. Third, a model, The Patient's Decision in Discharge Planning: A Continuum, is presented where a safe discharge plan is at one end of a continuum, while an unsafe discharge plan is at the other end. Respondents respect personal autonomy and the patient's self-determination to a point. This point is likely to be located in a gray area where the patient's decision crosses from one end of the continuum to the other. When patients decide on an unsafe discharge plan, workers' interventions range from autonomy to paternalism. And fourth, the hospital setting as an outside influence may not offer the best opportunity for patients to make decisions (a) because of beliefs family members and health care professionals hold about the value of patient self-determination, and (b) because patients may not feel free to make decisions in an environment where they are surrounded by family members, health care professionals, and social work respondents who have power and who think they know best. Workers need to continue to educate elderly patients about their right to self-determination in the hospital setting. ^

Empowerment, social support, and self -esteem of parents involved in an elementary school program

Parent involvement (PI) in schooling has consistently been correlated with improved academic achievement in children. However, despite the apparent benefits of parent involvement, many schools serving low-income communities report consistent difficulty in facilitating the involvement of parents in their children's schooling. ^ The purpose of this exploratory pilot study was to examine key variables associated with a PI program at a school that served a low-income community. The program was selected because it sustained the involvement of parents for a prolonged period of time. It was also selected because the program was facilitated by social workers. ^ Derived from the literature, four lines of inquiry were examined: (a) the relationship between PI and parent strengths and development; (b) the relationship between PI and children's academic achievement; (c) facilitators for PI; and (d) barriers to PI. These lines of inquiry yielded the study's four primary research questions. The study employed a cross-sectional research design to address them. ^ Thirty-three parents, representing 16 school-involved (SI) parents and 17 non-school involved (NSI) parents, served as study participants. All 33 parents resided in a high poverty community. ^ Quantitative methods were selected to examine differences between study participants and PI. Measures of parental empowerment, social support, self-esteem, and direct and indirect measures of their children's academic achievement were utilized. Qualitative methods were developed to identify and describe SI and NSI parents' perceptions of facilitators for and barriers to PI. ^ This study's findings suggest that PI may yield important benefits for SI parents. These benefits include parents' perceptions of their empowerment, social support, and self-esteem. This study's findings also suggest a relationship between PI and reduced rates of children's school suspensions. This study did not, however, support relationships between PI and children's standardized test scores. This study concludes that despite the apparent benefits of PI for SI parents, PI may nonetheless be a proxy for several unspecified interventions that effect parents, children, schools and communities alike. More precise specifications and robust measures of PI are needed. ^

Empowerment, social support, and self-esteem of parents involved in an elementary school program

Parent involvement (PI) in schooling has consistently been correlated with improved academic achievement in children. However, despite the apparent benefits of parent involvement, many schools serving low-income communities report consistent difficulty in facilitating the involvement of parents in their children's schooling. The purpose of this exploratory pilot study was to examine key variables associated with a PI program at a school that served a low-income community. The program was selected because it sustained the involvement of parents for a prolonged period of time. It was also selected because the program was facilitated by social workers. Derived from the literature, four lines of inquiry were examined: (a) the relationship between PI and parent strengths and development; (b) the relationship between PI and children's academic achievement; (c) facilitators for PI; and (d) barriers to PI. These lines of inquiry yielded the study's four primary research questions. The study employed a cross-sectional research design to address them. Thirty-three parents, representing 16 school-involved (SI) parents and 17 nonschool involved (NSI) parents, served as study participants. All 33 parents resided in a high poverty community. Quantitative methods were selected to examine differences between study participants and PI. Measures of parental empowerment, social support, self-esteem, and direct and indirect measures of their children's academic achievement were utilized. Qualitative methods were developed to identify and describe SI and NSI parents' perceptions of facilitators for and barriers to PI. This study's findings suggest that PI may yield important benefits for SI parents. These benefits include parents' perceptions of their empowerment, social support, and self-esteem. This study's findings also suggest a relationship between PI and reduced rates of children's school suspensions. This study did not, however, support relationships between PI and children's standardized test scores. This study concludes that despite the apparent benefits of PI for SI parents, PI may nonetheless be a proxy for several unspecified interventions that effect parents, children, schools and communities alike. More precise specifications and robust measures of PI are needed.

Using structural equation modeling to assess two theoretical models that explain dropout

This study evaluated the relative fit of both Finn's (1989) Participation-Identification and Wehlage, Rutter, Smith, Lesko and Fernandez's (1989) School Membership models of high school completion to a sample of 4,597 eighth graders taken from the National Educational Longitudinal Study of 1988, (NELS:88), utilizing structural equation modeling techniques. This study found support for the importance of educational engagement as a factor in understanding academic achievement. The Participation-Identification model was particularly well fitting when applied to the sample of high school completers, dropouts (both overall and White dropouts) and African-American students. This study also confirmed the contribution of school environmental factors (i.e., size, diversity of economic and ethnic status among students) and family resources (i.e., availability of learning resources in the home and parent educational level) to students' educational engagement. Based on these findings, school social workers will need to be more attentive to utilizing macro-level interventions (i.e., community organization, interagency coordination) to achieve the organizational restructuring needed to address future challenges. The support found for the Participation-Identification model supports a shift in school social workers' attention from reactive attempts to improve the affective-interpersonal lives of students to proactive attention to their academic lives. The model concentrates school social work practices on the central mission of schools, which is educational engagement. School social workers guided by this model would be encouraged to seek changes in school policies and organization that would facilitate educational engagement. ^

Aggression toward homosexuals: Prevalence, correlates, and motives for antigay behaviors among adolescents and young adults

This study examined the motivating factors for perpetrators of antigay harassment and violence among 752 college freshmen. Large numbers of lesbians, gay men and bisexuals (LGB) are victimized solely because of their sexual orientation. The physical and psychological harm suffered by many of these individuals is alarming. In particular, victimization at school is correlated with a variety of other health risks for LGB students. In order for prevention efforts to be effectively tailored, it may be helpful for researchers to first identify what motivates the assailants. This study tested variables capturing demographic, psychosocial, and attitudinal factors. This purposive sample was selected because these students represent the age group most likely to become perpetrators. The findings suggest that harassment of gay people is common and, in many cases, not motivated by particularly negative attitudes toward homosexuals. Instead, LGB individuals may be viewed as a socially acceptable target by others to harass out of boredom, anger at someone else, or in an attempt to assert their own threatened heterosexuality. Social norms, along with the variety and weakness of individual predictors for antigay harassment, further suggest that heterosexism is endemic and pervasive in our society. Physical attacks against homosexuals, although less common, represent a more serious problem for the victims. This study discovered that there were some leading predictors for these assaults, namely, being male, having been maltreated, being a heavy social drinker, and having defensive, antigay attitudes. The implications of these findings and imperatives for social workers are discussed.

Organizational culture, organizational climate, and collaborative capacity for planning

The objective of this study was to investigate the relationship of organizational culture and organizational climate on participant perceptions of collaborative capacity for planning, within the context of the Florida School Readiness Coalitions (FSRCs). Three hypotheses were proposed for study: First, that organizational culture would be correlated to organizational climate; second, that organizational culture would be correlated to collaborative capacity for planning; and the third that organizational climate would be correlated to collaborative capacity for planning. ^ A cross-sectional survey research design was used to obtain data from participants in 25 Florida School Readiness Coalitions. Pearson product-moment correlations were used to examine the association between the dependent variable, collaborative capacity for planning, and the independent variables, organizational culture and climate. Bivariate analyses revealed a significant level of association for five culture indicators to collaborative capacity for planning: motivation, interpersonal, service, supportive and individualistic indicators, and four climate indicators: cooperation, job satisfaction, organizational commitment, and role clarity. Findings suggest (a) a constructive culture and positive climate were present within the FSRCs during the period of study and (b) participants perceived that the collaborative capacity for planning existed. Hierarchical multiple regression, controlling for effects of participant demographics, were used to examine the degree to which organizational culture and climate predict collaborative capacity. The culture indicators, supportive and individualistic, and the climate indicator job satisfaction accounted for 46% of the variance in collaborative capacity for planning. No other indicators of the independent variables demonstrated significance. The findings suggests that (a) culture and climate should be studied together, (b) culture and climate are two constructs that may provide knowledge about the way community groups work together, and (c) the collaborative capacity of groups planning services such as the FSRCs may benefit through consideration of how culture and climate affect service planners' relationships, communication, and ability to achieve a mission or goal. Culture and climate may offer social workers new information about internal factors affecting the collaborative process. Further investigation of these constructs with other types of groups is warranted. ^

From foster care to college: Young adults' perceptions of factors that impacted their academic achievement

Despite increased Federal, state, and local efforts in the United States to improve outcomes among young adults who emancipate from foster care, low educational achievement and attainment continue to characterize this vulnerable subpopulation. Approximately 50% of foster children do not obtain a high school diploma or a general equivalency diploma (GED). Only about 20% of former foster children enroll in college, compared to 60% of youth not in foster care. The purpose of this study was to explore, describe and explain the perceptions of college students who had lived in foster care regarding the external and internal influences that impacted their academic achievement and attainment. Interviews with a purposefully selected sample of 24 Florida college students were conducted; transcripts were coded and analyzed thematically. Findings included that participants experienced a particular set of external and internal influences at school, in foster care settings, and in the community. External influences include interactions with (a) multiple non-relative guardians and case workers, (b) relatives, especially siblings, (c) mentors, (d) teachers and school administrators, and (e) school counselors. Internal influences include the barriers of anger and bad behavior and a newly identified set of internal characteristics, called success strengths by the researcher, that promote academic achievement and college attainment. Implications are as follows: (a) Future theory on academic achievement concerning foster youth should reflect the importance of the affective aspect of school interactions. (b) Policy should mandate awareness training for educators, social workers, and other adults who work with former foster youth to increase professionals' awareness of the barriers, supports and success strengths that impact the academic lives of children and youth in foster care. (c) Adult educators and human resource development professionals should develop and implement appropriate new education and training materials and interventions. Future research may include a similar interview with former foster youth who graduated from college and with foster youth who leave school before graduating. Finally, a study with a nationally representative sample of college enrolled former foster children should be conducted to determine the relative importance of the barriers, supports and success strengths identified in this study.

Hospital discharge planning in the provision of food and nutrition services for older adults post discharge

This descriptive study examined whether discharge planning ensures that food and nutrition services are provided to older adults following hospital discharge. The questionnaire was distributed to discharge planning professionals in 11 South Florida hospitals. Of the 84 respondents (88% response rate), most were female nurse case managers. Almost all reported job barriers including excessive patient loads, too many responsibilities, and limited community services. While physicians, registered nurses, social workers, physical therapists, were deemed "very important" in discharge planning,registered dietitians were not, and almost half consulted them infrequently, if at all. Over 84% said nutrition-related medical conditions/factors, "strongly influenced" discharge planning. Many did not have adequate information about nutrition-related community resources, eg, home delivered meals, food stamps, outpatient registered dietitians. Therewere no universal approaches in meeting the nutrition needs in 6 case scenarios. More communication among community services and hospitals is needed.