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2012-2013 MSW Fellows in Aging

The Rutgers School of Social Work selected five MSW students as 2012-2013 MSW Fellows in Aging. These students were selected for their strong commitment to social work and aging, as well as their great potential as leaders in this field. The Fellows completed leadership projects in April of 2013 as part of their advanced MSW internship at aging-focused agencies throughout New Jersey.

 

 

"The Clinician’s Ability to Address Issues of Sexuality with Older Adults"

Shaina Goldberg, Jewish Family Service of Greater MetroWest Older Adult Department

Background: Jewish Family Service of Greater MetroWest’s Older Adult Department in Florham Park, New Jersey serves as a resource for a wide range of services for seniors. Part of Jewish Family Service’s mission is to provide innovative social services to individuals at all stages of life. Currently, there is a lack of training available for clinicians regarding older adults and sexuality. Clinical assessments from agencies often disregard the relevance of an older adult’s sexuality. Also, older adults have limited access to information about the transmission of Sexually Transmitted Infections (STIs). There is an increase in STI’s among people who are above the age of 50 (CDC, 2008). Additionally, the lack of services for lesbian, gay, and transgender seniors is clear in the negative financial and social impact that being an older homosexual senior has (Morrow & Messinger, 2006). As a social worker, the clinician has an ethical responsibility to address issues of oppressed and vulnerable populations. Therefore, addressing issues of sexuality with seniors is a necessary part of a comprehensive assessment. 

Project Aims: The aim of this project is to open dialogue between clinicians regarding older adults and sexuality as well as to educate clinicians about the need to develop a level of comfort in discussing older adult client’s sexuality. To address this goal, I examined peer-reviewed research on this topic, as well as through informational interviews with clinicians. Through this research I developed a seminar to encourage open discussion and a dissemination of factual and relevant information regarding seniors and sexuality. This seminar was presented to 8 members of the older adult department at Jewish Family Service. A post-seminar survey was conducted to measure the impact of the seminar, including assessing clinicians’ interest in furthering their understanding of the dynamics of older adult’s sexuality as well as suggestions for improvement.

Outcome: Clinicians reported through the post-seminar survey that the presentation was informative and they felt encouraged to address issues of sexuality with senior clients. Additionally, as an outgrowth of my presentation to the older adult staff, the agency is working on bringing more educational programs on topics related to sexuality to the entire faculty of Jewish Family Service of Greater MetroWest. The most significant outcome of my project is the addition of a question about a person’s sexuality to the agency’s psychosocial intake document for all new clients. The addition of these questions regarding client’s sexuality is a huge step towards allowing conversations regarding sexuality emerge as a normal component of the therapeutic process. 

Reflection: The development and implementation of this project encouraged me to look deeper into an issue that many people are uncomfortable speaking about.  I was thrilled with the outcome of the presentation, the attendees’ responses to my project were positive, and it sparked a great deal of conversation and change within the agency. My plans for the future of my project include presenting the seminar at other agencies serving the older adult population as well as providing other members of the clinical staff at Jewish Family Service with a meta-analysis of my findings on older adults and sexuality in clinical practice. Recognizing the positive changes that took place after my presentation, it is evident that providing this seminar to other social service agencies serving older adults may encourage agency change and increased comfort in speaking with seniors about sexuality.

References:
Centers for Disease Control and Prevention (2012). Persons Aged 50 and Older.  Division of HIV/AIDS Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, 21. Retrieved from http://www.cdc.gov/nchhstp/.
Morrow, D. F., & Messinger, L. (2006). Sexual orientation and gender expression in social work practice: Working with gay, lesbian, bisexual, & transgender people.  New York: Columbia Univ. Press.

 

 

"Addressing the Needs of Older Adults Transportation Transitions in Essex/Union Counties in NJ"

Louis Hoffman, New Jersey Travel Independence Program (NJTIP)

Background: Many older adults drive past their ability to do so safely as a result of physical and cognitive changes associated with aging. Traffic accidents are a leading cause of fatalities for older adults. Many would stop driving, but they are unaware of the alternatives. Services do exist to help older adults maintain mobility and independence even when they are no longer able to drive. In order to address the need for more clear and concise information about available services and how to use them, the New Jersey Travel Independence Program (NJTIP) provides travel instruction services throughout New Jersey. Currently, NJTIP provides travel instruction services that teach people about many of these transportation options with on the road instruction to seniors and others who apply for Access Link ADA paratransit through funding allocated by NJ TRANSIT ADA Unit. 

Project aims: This project aims to improve the reach and effectiveness of NJTIP’s programs to address the transportation needs of older adults in New Jersey by, 1) Conduct informational interviews with relevant organizations within Essex and Union Counties, statewide and national organizations as well as other stakeholders (e.g., older adults), about transportation services and service gaps for older adults, 2) Review the scholarly literature for models that support older adults’ before, during and after driving cessation, and 3) Identify long term funding sources and communities with appropriate services and interest in supporting a senior mobility program. 
 

Findings: Conversations with professionals and older adults’ service recipients within New Jersey and from around the country highlighted the need for a full spectrum of transportation services for the older adult population and to find additional avenues for disseminating this information to older adults. These discussions illuminated multiple types of transportation services, which range in their levels of flexibility, support, accessibility and cost. These conversations highlighted the need for assistance in understanding information about the services and which services are most appropriate for each individual. This is necessary in many communities however the transportation services in New Jersey are especially confusing because of the many layers of services provided by municipalities, counties, NJ TRANSIT, the Port Authority as well as private carriers. To make this more confusing branding is often unclear as many vehicles are owned or were previously owned by NJ TRANSIT and still bear remnants of their branding yet local agencies, counties or private carrier may be the service provider. This is one reason why it is so important to have concise and complete resource guides to share information with seniors and the professionals that serve them.

Scholarly literature confirms the needs that became evident in conversations between the travel trainers and older adults. The findings suggest that older adults are more successful at transitioning away from driving without losing mobility when they have a peer and professional network of support. The NJTIP program strives to build this network of support and make information and services more accessible for all stakeholders. This effort has most recently been exemplified in the NJTIP/Greater MetroWest “On The Go” model, which brings community partners and concentrations of older adults living in the community together. Intervention strategies include peer training, professional “Connect to Transit” training, environmental barrier analysis, group familiarization and transportation forums. Through the process of this aging fellowship the model was analyzed. Scholarly literature and interviews with a host of multidisciplinary professionals from agencies providing aging services and transportation around the country have been consulted. One effort used in many programs across the country which contributes to the sustainability of the model is enhanced by training provided to professionals and seniors to help others understand services as well as by the guides to public transportation customized for each community served.

 

In 2013 “On The Go” will be implemented using this revised model in West Orange, NJ with the Jewish Community Housing Corporation and the Jewish Federation of Greater MetroWest NJ. NJTIP sought long term funding streams through this leadership project and has identified potential funding opportunities; some of these funding possibilities include Community Transportation Association of America, or another NJ Foundation for Aging grant.  Longer term funding for this project may come from “MAP 21” Federal Transit Administration funds as well as New Jersey Department of Transportation or local/county funding sources.  

Reflections on my leadership development process: This aging fellowship project provided an opportunity for reflection and planning outside of the normal funding.  Literature and technical assistance from outside agencies was also utilized to improve the model. Using principles of strategic planning reasonable aims for NJTIP were analyzed. Principles of program planning were used to demonstrate a timeline and plan of how the project will be implemented. Principles of financial management were also used to create budgets for different programmatic and funding possibilities. Professionals on the national level and individuals in senior housing provided many perspectives that have affected changes at micro, mezzo and macro levels. This has been a defining experience for me as a Nonprofit and Public Management student and for NJTIP. The products of this fellowship will have a lasting impact on the partnering agencies and the safety and mobility of older adults across the state of New Jersey.
 

 

 

"Hand to Hand: A Resident Peer Mentoring Program"

Rajini Kurian, the Francis E. Parker Memorial Home

Background:  Transitioning to new living environments is often a difficult process; however, it is especially challenging for seniors who leave their families and communities behind to live in assisted living facilities. Transitions such as these can lead to feelings of loneliness and helplessness, and may result in mental health issues such as depression (Eden Alternative, 2009).   The Francis E. Parker Memorial Home provides long term care to older adults in its assisted living and skilled care nursing communities. Our ENDEAR program (Eradicating depression by Noticing when changes may be Developing in our residents through Education and Engagement, Assessment, Referral) aims to prevent these potential issues and promote engagement. Engaging new residents is important for preventing loneliness, which accounts for a large part of why seniors suffer from depression. My project “Hand to Hand: A Resident Peer Mentoring Program” was developed for the assisted living community: Parker at Stonegate.

Project aims: The proposed program “Hand to Hand: A Resident Peer Mentoring Program” engages new residents through mentoring with the aim of preventing loneliness, and hopefully in the long term, preventing depression. Through a mentoring partnership, new residents will receive help acclimating to their new home, experience socialization, and be able to provide their loved ones who are worried about adjustment, peace of mind. To develop this program I, 1) conducted interviews with a variety of professionals working in long term care settings, 2) conducted a literature review of scholarly publications relevant to this topic, 3) developed a mentoring curriculum that could then be implemented, 4) started to lay the framework to implement this project. 

Findings: To research models for creating a mentoring program of this kind, I contacted several professionals working in long term care settings. This resulted in the realization that this was not being done or had been unsuccessful at one point in time. In designing an approach specific to this setting, I interviewed various staff members and residents of Parker at Stonegate. This helped to produce a program that would be of interest not only to a prospective mentor but also to the mentee. Four veteran residents were recruited to become mentors in this role. Mentors are required to attend a training session prior to their first meeting with their mentee. The training for mentors provides an overview of the program, including guidelines for mentors, exploring and valuing diversity, relationship building, effective communication, responsible mentoring, and closure. A mentor will be assigned interested new residents. Each mentor and mentee will meet once every two weeks for the first four-months from when the new resident moves to Parker. At the end of the mentoring partnership, both the mentors and mentees will be asked to fill out an evaluation form. Specifically, the mentees will be given an opportunity to identify their interest in becoming a mentor for future new residents. While the program has not yet been implemented, critical parts to the process have been completed: recruiting mentors, establishing operational standards and other operations materials, and producing detailed training documents to educate the mentors on their role and expectations.  

Reflections on my leadership development process: This project has given me a new appreciation for the complexity associated with developing a new program. Throughout this process I developed the ability to look at the bigger picture while still attending to the details. I learned how to work independently while simultaneously assessing when to consult with others. I have also realized how valuable the input of colleagues and supervisors is to the development process, and continue to be grateful to the ENDEAR program committee throughout the process of developing the Hand to Hand program. Moreover, the work put into the development of the program was commended and recognized as high quality; I have been asked to return to Parker to present the program to the Senior Executive Leadership team. The plan for the future is to have a program that can be used as a best practice for other assisted living communities.   
 

 

 

"Integrating Therapeutic Touch with End-of-Life Care"

Erin Mickelwaite, Princeton Hospice

Background:  Princeton Hospice consists of an interdisciplinary team including a medical director, nurses, social workers, and a chaplain who work together to provide comfort care for patients who have a terminal illness. Members of the care team continuously assess and track patients through the dying process and work together to provide comprehensive care.  One important aspect of end-of-life care is that of therapeutic touch. Older people, and those who have significant illnesses, are among the least frequently touched portion of the population (Meek, 1993), especially those residing in long-term care facilities (Nelson, 2009). However, therapeutic touch has been demonstrated to improve well-being for individuals receiving end-of-life care (Ziembroski et. al., 2003, Kutner et. al., 2008).  Although Princeton Hospice does offer some therapeutic touch services such as Reiki therapy, the majority of the care team do not receive explicit training about therapeutic touch. In this project, I focused on increasing the frequency with which Princeton Hospice patients received therapeutic touch through educating staff and volunteers.  My own expertise as a practicing, licensed massage therapist in New Jersey afforded me a unique opportunity to fuse my working knowledge of therapeutic touch with hospice social work.  

Project aims: To accomplish this goal, I conducted a literature review to examine evidence-based practices that utilize therapeutic touch with the intention of integrating these into the care model used by Princeton Hospice. Second, I sought to facilitate greater awareness about the benefits of therapeutic touch for hospice staff, volunteers and nursing home staff to increase their comfort level and willingness to use appropriate touch with patients. I utilized experiential in-services to disseminate this knowledge and provide further instruction on therapeutic touch. Third, I aimed to evaluate the efficacy of this training. Finally, I sought to create an information packet that will remain available at the Princeton Hospice offices.

Findings: Altogether, I conducted four in-services. These were attended by a cohort of twelve hospice volunteers, five members of the hospice interdisciplinary team, ten nursing students who were completing a rotation in hospice as well as four members of the activities department and six certified nurse’s aids (CNA’s) at a local nursing home served by Princeton Hospice. Those who attended commented that the information greatly increased their comfort level with providing appropriate and therapeutic touch to patients and some remarked that they planned to incorporate the techniques they learned into daily patient care. Several of the more experienced volunteers had been using some form of therapeutic touch for patients and were eager to learn more. The nursing students reflected that although touching patients in a therapeutic manner was not something they had encountered in their curriculum, they felt it was quite important. Participants reflected that because they often make task-oriented physical contact with residents, learning several therapeutic techniques would enhance their ability to provide care. The CNA’s noted that they felt there was not enough free time for them to incorporate many of the techniques into their daily care routines for patients due to a high patient-to-CNA ratio. 

Reflection on my leadership development process: The project was an excellent way for me to challenge myself to become more comfortable presenting information formally in a small group setting by selecting in-services as my primary means of disseminating information. The project has allowed me to develop stronger communication skills and to experiment with various pedagogical techniques that will support my career in social work going forward.  As a licensed massage therapist and a social worker, I will have the opportunity to present this information to local nursing homes and other agencies that work with patients who receive end-of-life care. 
 

 

 

"Enhancing Hospice’s Therapeutic Child Bereavement Services"

Julie Stewart, Vitas Hospice

Background: Vitas Hospice provides end-of-life care to terminally ill patients, working with both the patient and their families to ensure comfort and preserve dignity.  Because coping with death and dying can be an extremely complex and difficult task, especially for children, bereavement services for family members are an integral part of hospice care. Vitas Hospice provides psychosocial and bereavement services not only to the patient, but to the patient’s loved ones, including their children and grandchildren, while on service and for thirteen months following death. This project will provide a guide for grieving parents on how to address the difficult subject of death with their children.

Project Aims: The purpose of this project was to identify best practices in children’s bereavement that will enhance their bereavement care plans to ensure high quality end-of-life care to patients and their families. My first aim was to research best practice strategies regarding children’s grief process, particularly regarding the death of a grandparent. My second aim was to gather input from multiple sources, such as Vitas’ interdisciplinary team (including nurses, medical doctors, social workers, chaplains, health aides), from local and national hospice agencies, and from research on the child bereavement process, interventions, the grandparent-grandchild relationship, and cultural considerations surrounding death and dying. The third aim was to develop a resource packet that families can use when working with their child through the death of   a grandparent. In the long term, another goal of this project is to acknowledge and preserve the patient and the family’s dignity and values. 

Findings: Key findings from this project are that bereavement is family-focused and needs to be tailored to families’ values and cultural background.  Parents play a key role in child bereavement and parents need to be prepared both educationally and emotionally on how to address the issue of ‘death’ with their child(ren). Social workers can aid in preparing parents for these discussions. Parents need use honest, sensitive, and engaging communication.  Research shows that parents who are not “open, sensitive, and responsive” risk leaving their children “ill-prepared through immaturity and inexperience,” which frames how children will cope with later life stressors (Kirk and McManus, 2002, p. 470). Age-appropriate grief support is crucial. Because parents are the key player in the bereavement support, remind them that it is important to understand their own grief and the importance of their own self-care.

Grandparents are often scared holders of familial heritage, culture, and values.  Their stories and memories have the potential to leave a lasting legacy only adult children and grandchildren if bereavement is addressed properly to keep the memories of their loved one alive.  Social workers should encourage ‘verbal discussions’ of the lost loved one, which allows for a reflection of memories, engagement of affect, and disclosure of thoughts and feelings, which is both ‘therapeutic’ and can ‘help decrease grief symptomatology’ (Tonkins and Lambert, 1996). To ensure sustainability, I put together “bereavement packets” for the Vitas team that incorporates already available, yet underutilized, literature on the child bereavement process and activities for parents to do with their children.  I included summaries of my research to support each key point in the bereavement packet.   

Reflections on my leadership development process: This project enhanced my leadership skills in a variety of ways.  It prompted me to interview people of several disciplinary backgrounds and translate their advice for a broader audience.  In this sense, I strengthened my collaboration and communication skills.  Furthermore, I strengthened my research skills, both formally (through evidence-based research) and informally (through team member communication and feedback). The project required me to gather information from a larger context (scholarly articles, other hospice agencies, team members) and incorporate that into the local, organizational context.  Lastly, this project taught me the importance of persistence both in my personal and profession endeavors. Personally, I have a passion for intergenerational work, which is currently under-acknowledged and under-researched. This project required me to conduct my own personal research to supplement the minimal research currently surrounding this issue. Professionally, I learned to advocate for my belief of the importance of an issue using personal and professional research and presenting the issue in a way that illustrates its relevance and pressing nature to a population who does not fully understand its importance. The knowledge gained from this project about children’s grief experiences, as well as the skills I developed in effective communication, leadership, research, and interdisciplinary collaboration will follow me throughout my professional career.  

References:
Kirk, K., & McManus, M. (2002). Containing families' grief: therapeutic group work in a hospice setting. International Journal Of Palliative Nursing, 8(10), 470-480.
Metel, M., & Barnes, J. (2011). Peer-group support for bereaved children: A qualitative interview study. Child & Adolescent Mental Health, 16(4), 201-207. doi:10.1111/j.1475-3588.2011.00601.x 
Tonkins, S., & Lambert, M. J. (1996). A treatment outcome study of bereavement groups for children. Child & Adolescent Social Work Journal, 13(1), 3-21.

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