R TFORDFOOE J HN A.HANTHU N D ATIO1929Generalist Social Work Practice withIndividuals, Families and Groups IITeaching CasebookRavazzin Center for Social Work Research in AgingFordham UniversityGraduate School of Social Service

R TFORDFOOE J HN A.HANTHU N D ATIO1929Generalist Social Work Practice withIndividuals, Families and Groups IITeaching CasebookFaculty Case Development Team:Margaret Souza, MSW, Team LeaderDavid Koch, Ph.D.Yvette Sealy, Ph.D.Judith Smith, Ph.D.Ravazzin Center for Social Work Research in AgingFordham UniversityGraduate School of Social Service2003This project was made possible by a grant from the John A. Hartford Foundation

Table of ContentsIntroduction1Gerontology Competencies2Generalist Practice with Individuals, Families and Groups II Case:The Senior Center Group5Teaching Guide8Gerontological Competencies8Planning the Group9Pre-Engagement11Beginning the Group11Working with the Group13A Suggestion for an Additional Way to Use the Case14Doing Group Work with Special Populations15Termination16Background Readings for Faculty17Faculty Readings for Case Preparation17Other Resources Provided in This Casebook17Material Recommended for Distribution to Students17Video Available at Fordham17Other Resources not in this Casebook18Background Readings for FacultyClark, P (2002). Values and voices in teaching gerontology and geriatrics:case studies as stories. The Gerontologist, 42 (3), 297-303.“What do you know about aging? Facts and fallacies” from the Pacific NorthwestExtension.Fordham University Graduate School of Social Servicei

Faculty Readings for Case PreparationMcInnis-Dittrich, K. (2002). Social work with elders: A biopsychosocial approach toassessment and intervention. Boston: Allyn & Bacon. ( 154-158).Orr, A. (1994) Dealing with the death of a group member: visually impaired elderlyin the community. In A. Gitterman, A. & L. Shulman (Eds.) Mutual aid groups,vulnerable populations and the life cycle. New York: Columbia University Press.Watt, Lisa & Wong, Paul T.P. (1991) Taxonomy of reminiscence and therapeuticlimitations. Journal of Gerontological Social Work. 16 (2) 37-57.Other Resources Provided in This Teaching Casebook“Facts about senior centers” from The National Council on the Aging“The many faces of aging: Lesbian, gay, bisexual, and transgender older persons”from the U.S. Administration on Aging“Aging and alcohol abuse” and Age Page from the National Institute on AgingMaterial Recommended for Distribution to Students“Reminiscence: An important task for older adults” from the Texas CooperativeExtensionFordham University Graduate School of Social Serviceii

IntroductionThis teaching casebook was developed as part of the Geriatric Enrichment in Social WorkEducation project funded by the John A. Hartford Foundation to the Ravazzin Center at theGraduate School of Social Service. The goal of this project is to integrate material on aging into thefoundation year practice courses. The foundation year faculty supports the use of cases that includeolder adults as the way to teach foundation practice skills.As you know, our society is rapidly aging, and we can anticipate that all social workers willencounter older persons in their practice regardless of the setting. When students are exposed toaging content throughout their coursework, they will be better prepared to serve older adults andtheir families.Each foundation practice will use a case specifically designed to fit within its syllabus. Thiscasebook includes the case and materials to help prepare you to use this case. The expectation isthat the case will be used in one class session. However, it can be used for additional sessions.Supporting materials are included should you decide to use the case beyond the one class session.The selection of cases was the result of the work of a faculty task force. These cases were carefullyconstructed so that negative stereotypes regarding older persons are not reinforced. The casebookwas prepared by a team of faculty members to provide teaching faculty with all the material theyneed to effectively use the case.Included in your casebook are: Gerontological competencies that fit into the foundation practice courses The case and where it fits in the curriculum Suggestions for how the case can be used Additional learning activities Background reading for faculty Faculty readings for case preparation Other resources available in the casebook Materials recommended for distribution to students Additional resourcesWe hope this casebook will enable you to comfortably introduce gerontological content into thecourse even if you do not have experience in the field of aging. Moreover, we hope that thematerials we provide will demonstrate that case examples that include older adults and theirfamilies are as effective a tool for teaching generalist practice as cases focused on other populations.We look forward to learning about your experiences in using this case and the supporting materials.Irene A. Gutheil, D.S.W.Project DirectorFordham University Graduate School of Social ServiceRoslyn Chernesky, D.S.W.Curriculum Consultant1

Gerontology CompetenciesOn the next page you will find a list of generalist competencies viewed from a gerontological lens.These gerontology competencies reflect the generalist knowledge and skills that we expect ourstudents to demonstrate at the end of the foundation phase of their education. A faculty task forceagreed that these competencies are appropriate expectations for students completing Fordham’sfoundation curriculum.The competencies are presented in four areas. As you will see, these areas are the same as forpractice with all populations. Within each area the generic competencies are applied to work witholder adults and their families. We hope that students will recognize the relevance of thesegerontological competencies to their social work practice in general.Each casebook identifies the particular competencies addressed in the case. Using the designatedcompetencies as a guide to teaching from the case will insure that students are exposed to importantknowledge and skills.It is not necessary to focus directly on the competencies. However, we hope you will see them asoutcomes you are aiming to achieve through the use of the case.Fordham University Graduate School of Social Service2

R TFORDFOOE J HN A.HANTHU N D ATIO1929Fordham University Graduate School of Social ServiceGERONTOLOGY COMPETENCIESFoundation YearI.Assessment1. Conduct a biopsychosocial assessment of an older person which includes: Biological factors such as information regarding physical functioning (e.g., health,illness and functional ability) Psychological factors such as coping capacities, affect, and indicators of the need for amental status examination. Social factors such as: social roles (e.g., transitions, losses), social functioning, socialsupports, social skills, financial status. Family factors Cultural factors Spiritual factors Factors in the social and physical environment that affect the physical and emotionalhealth of older persons (understanding that the interplay of psychological, social, andphysical functioning is heightened in older persons).2. Recognize and identify family, agency, community, and societal factors that promote or inhibitthe greatest possible independence of the older client.3. Demonstrate awareness of sensory, language and cognitive strengths and limitations of clientswhen interviewing older adults.4. Engage with older persons utilizing their varying strengths.5. Recognize indicators of the need for more in-depth assessment of areas of concern (e.g.,substance abuse, elder abuse).Fordham University Graduate School of Social Service3

II.Treatment/Service Care Plan1. Set realistic and measurable objectives and establish care plans based on functional status, lifegoals, symptom management, and financial and social supports of older adults and theirfamilies.2. Reevaluate and adjust service/care plans for older adults to accommodate changes in their lifecircumstances.III.Case/Care Management1. Use social work case management skills to link elders and their families to resources andservices.2. Collaborate with other social service, health, mental health and allied health professionals indelivering services to older adults.3.IV.Assess and leverage organizational and community resources in meeting needs of older adultsand their caregivers.Interventions1. Engage older persons and family caregivers in maintaining and enhancing their mental andphysical health and functioning.2. Assist older persons and their families in dealing with stressful or crisis situations.3. Enhance the coping capacities of older persons, including abilities to deal with loss andtransition.4. Provide services to older persons and their families through group modalities.Fordham University Graduate School of Social Service4

Generalist Practice With Individuals, Families, and Groups II Case:The Senior Center GroupThis case scenario provides information about the setting for the group and the general focus of the group as well as abrief description of the social worker. In addition, a brief description of each of the group members is provided.The Senior Citizens Center in the Northside section of this large urban city has beenproviding an array of services to the community’s older adults for the past ten years. Housedin a renovated building, the Center serves approximately 300 seniors, primarily throughgroups and clubs provided for socialization and recreation, and congregate lunches. Becauseof its key location, next to a housing project with an increasingly large population that is“aging in place” and on the corner of a major bus route, older adults from nearbyneighborhoods are able to reach the center easily. The Center serves predominantly womenin their 70s and 80s, although a group of men attends regularly.The Center social worker is Cynthia a 27 year old, recent graduate who had relocated fromTexas because of her husband’s employment. As she got to know many of the members shethought it would be valuable to offer a special “reminiscence” group for those who may wishto recall earlier times in their lives. She contacted 4 women and 4 men individually andexplained to each the purpose of the group, what the activities or exercises might be, andwhere, when, and for how long the group would meet. She let each person know that thegroup was voluntary, and that after the first session no one who did not want to continue hadto. She added that she hoped that once they agreed to join, they would commit themselvesto attend all 12 sessions, which were to be held once a week. The group ended up with sixmembers (2 men chose not to attend).Pauline is an 82-year-old female who had moved to New York seven years ago withher elderly husband who subsequently died. She lives with his daughter. She marriedat the age of 67, has no family of her own, and is dependent upon her deceasedhusband’s family for support and assistance. She came to the Center for socializationand found a “new family” among its members. She has developed her artistic talentsand is one of its very active members and staunch supporters. Being somewhat of adependent personality, she is hesitant to ever criticize anyone. However, she hasbeen developing her ability in that area and with support is beginning to feel free toexpress negative comments.Esther is 77 years old. She has lived in the area for over 25 years. She recently losther sight in one eye, due to complications from diabetes. She continues to be veryactive, but is no longer confident about taking the bus or subway by herself because ofher physical limitations. She was born in Trinidad and came to the US when she was27. She is a US Citizen. She has been very active in her church – Seventh DayAdventists. Over the years, she has been President of the Youth Group, a member ofthe Choir, and President of the members’ association. She comes from a large family.Several family members with whom she is close live in Staten Island. Her recent eyesurgery makes traveling to see them difficult. Esther put herself through college in theUnited States. After getting her BA, she was employed by HUD doing programdevelopment for conferences. She learned to drive when she was 47. She is a veryupbeat person, who is liked by other people.Fordham University Graduate School of Social Service5

Ellen is a 75-year-old Jewish woman. She was never married and has no children.She has one sister who lives in Florida with her immediate family. Ellen has beenestranged from her sister for the past forty years yet does have some telephonecontact during the holidays with a niece and nephew. Ellen refers to her sister as theone who received the love and attention from their parents. Ellen states that most ofher friends from her youth are either deceased or too frail to maintain contact thesedays. She enjoys talking about working in the garment district in New York City duringthe 1940’s. Currently, Ellen has multiple health problems and is faced with supportingherself on Social Security benefits and a small pension. Due to her fixed income anddifficulty ambulating she receives Meals-On-Wheels services daily. The coordinatorfor the food program recognized that Ellen’s mood was often sad and withdrawn.Ellen begrudgingly agreed to attend the Center to increase her social supports. Ellenpresents herself as a very proud and private woman who was cheated of her “right tohave a family”. She is very protective of her emotions and tries to minimize her needfor companionship.Frank, one of the newest members of the group, is a 76-year-old Puerto Rican man.Frank is married with four children, two sons and two daughters. Frank retired fromthe Fire Department at age 60. He states that he had dreams of traveling and living acomfortable life after his retirement. While working Frank was treated for hypertensionand was cautioned by his doctor to cut back on his drinking. He has been known todrink a six-pack or two of beer daily. His alcohol consumption increased dramaticallywhen he retired. As a result of his alcohol use and unpredictable behavior he hasstrained relationships with his wife and children. The plans Frank had for hisretirement did not materialize and he finds himself with no focus or meaningfuldirection to his days. Frank is often frustrated by this loss of structure and is seekingan outlet where people are accepting of how he chooses to live his life.Allan is a 77-year-old white gay male originally from Memphis, Tennessee who isliving with HIV. Allan lost his partner to HIV two years ago and though he issymptomatic with HIV he is otherwise in fairly good health. He is isolated anddepressed since his partner died and has a limited social network. He has limitedfamily contact—a nephew and two nieces in Tennessee. And since his partner diedhas had diminished contact with his Brooklyn-based social network. He has beenretired for a number of years from his small Brooklyn hat shop. He has started comingto the senior center and has found the group helpful as he ruefully thinks about hispast.Bridget is a 67-year-old retired woman who had been employed in a major midtownhotel. Bridget came from Ireland during the early 1960’s after her mother died. Shehas a large family in Ireland and London and one brother in Pennsylvania who shesees infrequently. Bridget has the “gift of gab” and loves to be in a group where shecan be the center of attention.From the first session, the social worker played a directive and supportive role. A variety ofexercises were used to stimulate member interaction. These exercises usually wereenjoyable and also succeeded in getting meaningful discussions started. For example, in oneFordham University Graduate School of Social Service6

session, members were asked to bring in a favorite photograph to share with the group,which triggered some intense emotions. In another session, members spoke of their move toNew York and what the experience was like. They spoke of their health issues, role andstatus changes, and the adjustments and accommodation they had to make through theirlives and as they aged. A particularly intense session entailed a discussion of the significantrelationships in their lives.As the group progressed, members grew more willing to express themselves, got to knowone another, and seemed to feel better about themselves. Friendships developed.It is the 8th meeting of the group. Members arrived a little earlier to make plans for the first ofa members’ monthly birthday celebration. At that meeting, it became clear that the group wasno longer in need of the directive role that Cynthia had been providing, nor did they want herto continue it. She was perplexed and at a loss in terms of what to do with the group and howto proceed.Fordham University Graduate School of Social Service7

Teaching GuideGeneralist Practice with Individuals, Families and Groups IIThis case can be used in any of the class sessions devoted to working with groups. Although this caseis presented as a reminiscence group for older adults, and there will be opportunities to address thisspecifically, the case is designed to cover generalist course content on working with groups. Ascenario with role descriptions is offered here, along with questions for discussion and teaching points.It is suggested that the role descriptions be distributed the week before the class for students to roleplay the following week. Students should be asked to volunteer for the role play. Students shouldreceive only the role that they will be playing. Therefore, the instructor can xerox the case and cutapart each role scenario to distribute to the individual student who will be playing that role. Alongwith the role students should be instructed to think about what their character may be thinking andfeeling about the upcoming session. It is not recommended that you distribute all of the role scenariosto all of the students in the class in advance of the role play exercise. Students may become distractedby what they know about each character and not concentrate on the interactions of the players in thegroup.When the students act out the role play, it may be helpful to have each group member place a namecard in front of him/her with the character’s name and age.Gerontological CompetenciesThe gerontological competencies that fit into this foundation course are: Demonstrate awareness of sensory, language, and cognitive strengths of clients when interviewing older adults.Recognize indicators of the need for more in-depth assessment of areas of concern.Provide services to older persons through group modalities.Engage with older persons utilizing their various strengths.Engage older persons in maintaining and enhancing their mental and physical health andfunctioning.Assist older persons in dealing with stressful or crisis situations.Enhance the coping capacities of older persons, including abilities to deal with loss and transition.Fordham University Graduate School of Social Service8

Planning the GroupBefore the role play begins, the class should be presented with the information in the first twoparagraphs of the case. The instructor can elaborate on this information.Some questions for discussion1.What would be the advantage of working with these older individuals using a group methodology?Each of the people here has had some significant loss and is experiencing a degree of isolation. Whileattendance at the center, in itself, offers an opportunity for socialization, the group offers anopportunity to bond more closely with a small number of people, further reducing isolation.2.What would be the advantages of a reminiscence group in particular?Reminiscence groups have can have several functions as well described in Watt & Wong (1991),which is included in this casebook. They can serve as a pleasant diversion from present troubles or away to bond over common experiences. They can be “integrative,” that is, they can allow people toreview past experiences, achievements and failures and find meaning in their lives. Reminiscence canencourage people to reflect on past difficulties and think about what strengths got them though. This inturn can boost confidence in facing current problems. Reminiscence groups can also be vehicles fororganizing memories to pass on to younger generations. Such memories may be recorded for familymembers or for more public audiences.3.What other kinds of groups do you think would be of value to the older population?Older people, like those of any age, may benefit from mutual aid groups organized around lifetransitions, common problems, or challenging situations. Some kinds of groups commonly seen inagencies serving the elderly include: loss and bereavement groups for widows and widowers, groupsfor grandparents raising grandchildren, or for grandparents estranged from grandchildren because oftheir children’s divorce, support groups for sufferers of various diseases, such as stroke, cancer, etc.and new admission groups in long term care facilities.Older people also participate in social action groups, some intergenerational and some specifically forelders such as tenant councils in senior housing, gray panthers, etc. Older people also benefit fromactivity groups that foster interaction—book groups, poetry writing groups, painting groups etc.All these groups can be modified for people with some cognitive impairment. In addition there aregroups especially designed for those with moderate and even severe cognitive impairment. Thesegroups generally call on sensory memories of familiar sounds, sights, tastes and smells to jog somepersonal memories and reconnect the impaired to the world around them.Fordham University Graduate School of Social Service9

4. Are there any special issues to consider in planning a group for older people that might differ fromplanning decisions you would make for a younger group?Most planning considerations will be the same for older people as for all age adults. However, youshould consider the possibility that some people will have physical limitations requiringaccommodations. For example, if members have a hearing or speech deficit, you will want to seatthem near you, so that you can repeat what is said to/by them and help keep them in the group. Try tohold the meeting in a place removed from distracting noises. If possible, you could bring a portablemicrophone to help those with weak voices be heard by those with weak hearing. Lighting should begood and not require any members to look directly into the light. Chairs should be firm with arms toallow easy sitting and rising. If any members use wheelchairs or walkers, the space should be largeenough to accommodate these. If food is served, consider that some will be on special diets. Have fruitas an alternative to sweets. Many older people are reluctant to travel at night, so generally suchmeetings should be held during the day.5. What would be criteria for inclusion or exclusion of participants from the group?Inclusion should be based on interest and connection to the purpose of the group. Exclusion shouldonly occur if a member’s behavior or degree of impairment makes him or her disruptive to the groupor unable to benefit from the group. This sometimes happens in settings that serve persons withcognitive impairment along with those cognitively intact. People with wide differences in cognitiveability should probably not be grouped together.6. What organizational issues should be considered in planning for the group?Since this group is housed in a multi-service senior center, the worker must clear meeting time andspace with the administrator(s) of the center. It would be wise for her to meet also with other key staffwho: a) may be in a position to refer potential group members to her or b) who may run competingprograms either at the same time or on a similar topic. This will give her a chance to build support forthe group and address “turf issues” or other concerns that could lead some colleagues to undermine hereffort. If assistance is needed from others in the center, this should be lined up ahead. For example, aplan for refreshments could necessitate consultation with kitchen staff.7. What decisions does the worker have to make about selecting and inviting participants? Howcould she have recruited participants?Since this is a large senior center, there were many possible participants. If Cynthia chose to put up aflyer announcing the start of the group, she would probably have to find a way to select from amongall those who expressed interest. She could have asked her colleagues at the Center to refer membersthat they thought would be appropriate. Cynthia may have had her own contacts or relationships withmembers she could have invited. Of importance is making clear the purpose of the group and theexpectations of participation (e.g. once a week attendance, how long the group would meet, acommitment to attend all 12 sessions)Fordham University Graduate School of Social Service10

Pre-EngagementAsk the class to “tune in” to how various group members, including “the worker,” may be feelingabout their situation and about joining the group.Group members bring to the group all their feelings - loneliness, worries about their health, finances,family. Some may be eager for new experiences and meeting new people while others may not be surethey are ready for that. They may or may not be looking forward to an opportunity to reminisce, andwonder what that entails and whether they will be expected to expose themselves. They may worryabout sharing too much with center members whom they see so frequently. They may wonder if theyoung worker can understand what they have been through in life. At the same time, the worker maybe concerned about how she should relate to the group members and how to establish herself as aprofessional in a group that may relate to her as a daughter or grandchild.Beginning the GroupRole-play a first meeting for about ten minutes or so. It might be helpful to have name cards for thegroup members that include their ages. You could use sheets of heavy paper folded lengthwise withthe names and ages written with a felt pen.Some questions for discussion:The following are questions for students about the role-play:1. How was the direction/contracting of the group done? Were there ways these procedures weredone in this group that were related to the issues of members being elderly?2. How was confidentiality addressed? (Group members may well know each other’s friends andneighbors.)3. How was the group assured of emotional safety? (Note these elders have ongoing relationshipsoutside the group and may be reluctant to reveal too much personal information or feelings.)4. What sense prevailed for group members about “why we are here?” Was the worker clear inexplaining the group’s purpose?5. What beginning questions might get this group going?Consider Shulman’s (1999) “handles for work” (p. 101-102). This might be the place to introduce theidea of developing “safe” opening questions that will prompt group response but not be too threateningsuch as ‘Think of a pleasant memory you had that stays with you.” Or, more neutrally, allowing forpositive or negative memories: “Let’s go back to 19— (pick a year or decade) What do youremember?” This kind of question may trigger first memories of historical events – the Depression,World War II, etc., but will lead to more personal recollections.Fordham University Graduate School of Social Service11

6. The group members have some notable differences in background – religion, ethnicity, sexualorientation – which could be barriers to bonding. What commonalties might the worker reach forto help this group coalesce? How might these factors influence how the group members relate toeach other and to the group facilitator?7. What might be some of the differences in the way students played their role because they wereplaying older adults?Ask students who participated in the role-play what they did differently because they were supposed tobe elderly. Ask the class if they picked up any older adult “characteristics” that appeared in the roleplay. (Here you are looking for assumptions that students hold about older persons. For example,students may play the roles as frail, complaining, dependent individuals – all their own interpretationand embellishments of what it must like to be an older adult. Therefore, it may be necessary toconfront stereotypes being expressed).Here are some additional questions that you may have time for. You might want the class to resumethe role play for another ten minutes. If you do not get to all of the questions you wanted to address,consider using the case for a second week.8. Ask the participants of the groups how they felt about the group after the first meeting. Did theythink they would come back?9. Ask the student playing Cynthia, the group leader, how she felt about the meeting.10. What happened in the group?11. What evidence do you have to illustrate the engagement that was taking place in the group? Givespecific examples.12. What were signs of potential cohesion or of pulling away that occurred in the group?13. What were the signs of persons becoming dominant, who and how?14. What were specific issues for older persons that might need to be handled in this group?15. What effect did age difference have in the group interactions?16. What feelings and reactions might be going on for the worker dealing with a group of elders?17. Was the worker able to function effectively with this group of older persons? (You may want touse this opportunity to talk about some of the challenges facing a worker when (s)he is different insome significant way from the clients (s)he is working with in a group.)18. What might have been the differences in the group leader’s interaction

Education project funded by the John A. Hartford Foundation to the Ravazzin Center at the . Irene A. Gutheil, D.S.W. Roslyn Chernesky, D.S.W. Project Director Curriculum Consultant Fordham University Graduate School of Social Service 1 . Gerontology Competencies On the next page you will find a list of generalist competencies viewed from a .