This chapter highlights some of the current health programs and policies in place and changes in demographic trends for older adults living within American society. In addition, substantial changes within the social, political, and cultural expectations of communities over the past century pose challenges for policies and programs serving older adults. The chapter presents several issues emerge as realities within the context of policy development and program planning for older adults. These issues include changes in living arrangements, education levels, economic well-being, and rural population settings; trends in morbidity and mortality; and changes within the social, political, and cultural expectations of communities. Despite the availability of programs and services resulting from health policies, many programs have focused upon “medically necessary” services and have lacked a health promotion, health education, or community-based focus.

This chapter helps the reader to understand the history of housing and long-term care for older adults and people with disabilities and specific components of the Long-Term Care Reconciliation Act. The chapter discusses how legislation related to housing and long-term care provides resources to older adults and people with disabilities. It explains community-based care options such as home health, seniors congregate living, assisted living options, skilled nursing facilities, and long-term care facilities. Although differences may exist from state to state relative to who qualifies for these options and when they qualify, these will be discussed in some detail specifically providing an overview of these as options for care management of older adults. The chapter describes different residential models of care for people as they require community-based settings or settings with supports and examines issues that will face the long-term and community-based care settings in the future.

This chapter helps the reader to understand what a needs assessment is and be acquainted with a framework within which to conduct a needs assessment. and to be familiar with the core concepts of a needs assessment. It helps the reader to be familiar with strategies that encompass a needs assessment. Needs assessments can be carried out by a wide cast of people. Social workers and public health workers, as well as city planners, can carry out needs assessments, as can government organizations. Local citizens or groups of people can also be responsible for carrying out a needs assessment. The chapter provides an overview of strategies to develop a needs assessment. When used in combination with a health behavior framework, a needs assessment can help one determine the needs of a community and attempt to build community support for this resource or policy change through media advocacy and coalition building.

This chapter presents a brief overview of some legislative efforts within the mental health (MH) arena and examined their limitations and application with respect to older adults and people living with mental illness. The chapter also takes us through a journey to examine the current status of MH and older adults, with a particular emphasis on depression, anxiety, and schizophrenia. It discusses and reviews the programs, services and issues still outstanding within the MH arena. The chapter helps the reader to understand specific components of the Community Mental Health Act and other MH-related legislation. Many of the community day hospital programs and community MH programs administered through the Community Mental Health Act are based on the deinstitutionalization paradigm since the goal is to treat people outside the institution and within community settings. It concludes with laying out some challenges for the future in the area of MH and older adults.

This chapter discusses Older Americans Act (OAA). In the original act, the principles are defined through six specific titles. Title one: outlines the objectives and defines the administrative oversight for the OAA. It provides definitions for the administrative structure to carry out the OAA. This organization includes the secretary, commissioner, and the role that individual states will take on in the administration of the act. Title two: administration on aging establishes the infrastructure for the administration of aging services and outlines the main activities of this administrative structure. Title three outlines the authorization process of appropriations for the purpose of community planning, services, and training. Title four is about research and development projects. Title five: training projects outlines the provision of funds for training projects to benefit individual states. Title six outlines the advisory committees that govern the administration of the OAA.

This chapter deals with one subset of these strategies, namely using media as a part of the advocacy process. The chapter reviews a number of specific media advocacy strategies and provides some innovative approaches to sending a message relevant to program or policy development. Media advocacy is the strategic use of any form of media to help advance an organization’s objectives or goals. Media advocacy explores a number of key issues and serves to present strategies that can be helpful in the development of innovative human service opportunities and educate the general public. These strategies can be used as stand-alone methods or in combination with each other. These strategies build on understanding one’s health and help-seeking behavior and enable advocates to influence a wide number and array of people with limited resources and energy.

This chapter helps the reader to understand the history of the legislation related to substance use and misuse. It provides specific components of the Controlled Substances Act. The chapter discusses how legislation related to substance use and misuse provides resources to older adults and people with disabilities. Since substance use/misuse is often perceived as “blaming the victim”, models of care and rehabilitation are often not taken into serious consideration. Prevention, screening, detection, and intervention strategies to meet the needs of baby boomers as they age will be another challenge. Evidence suggests that substance use has been on the rise for the population in general among people living in the community. The chapter reviews programs and services and issues. The chapter concludes by laying out some challenges for the future in the area of substance use and abuse among older adults and people with disabilities.

This chapter focuses on sources of evidence for evidence-based policy development. It explores some of the dilemmas with developing an evidence base and provides a range of empirical sources within the aging and disabilities arenas that can be used in building an evidence-based approach to policy development. The journey, however, will not be without struggle—since philosophical paradigms, and social and economic factors will interface and play a role in the development of evidence-based policy. The chapter helps the reader to be aware of healthy people 2020 benchmarks that are used to guide program planning and policy development. Benchmarks currently have been established in order to identify where health goals for the nation and individual states should be, and the program is evaluated routinely by local and state health departments. Healthy people 2020 is also used to gauge the impact of health policy.

This chapter discusses the history of the Medicare in the United States; specific components of Medicare Parts A, B, C, and D; and how Medicare provides healthcare resources to older adults and people with disabilities. Medicare, a healthcare program perceived to be a universal program rather than one based upon a needs test, currently provides healthcare to people who reach the age of 64. Comprised of four parts, it can provide hospital care, general healthcare, hospice care, home healthcare, and prescription drug coverage. The chapter provides an overview of the Medicare program, its various components, and aspects of healthcare that are covered through its component parts. Although there are currently no needs tests or limitations as to who qualifies for services, the chapter concludes with some dilemmas for the future of healthcare coverage, including “an empty pot at the end of the rainbow” and rationing of healthcare services and procedures.

This chapter helps the reader to understand how to use tools such as health behavior models, the media, coalitions, and needs assessments to bring a vision to fruition and how to use advocacy tools for policy and program development. It also helps them to understand how to use advocacy tools to influence the practice arena for older adults and people with disabilities. The chapter reviews the various tools and strategies, along with policies that have been addressed thus far, and integrate these issues and skills with one’s vision for either program planning or policy development. When considering program development, all tools and strategies related to policy development apply equally. Some additional strategies or tools to use for program development include the health behavior models. This chapter attempts to integrate the theories and concepts and suggest how a program planner or policy advocate can apply them.

Aging policy is shaped by a variety of demographic, social, and economic factors. However, these factors are not the only influences on the development of public policy or aging/disability policies. Philosophical paradigms and theoretical frameworks also influence the actual development of policy and play a strong implicit role in how public policy is drafted. Values and philosophies guide the development of specific philosophical paradigms and shape how aging and disability policy is developed and implemented. This chapter explores how these realities play a role in the development and implementation of public policy and aging/disability policy. It showcases some of the realities that may prevent the implementation of the policy or program as envisioned. As a safeguard against a subjectively devised policy and program base, objective evidence and empirically driven initiatives can be developed by aging and disability policy advocates.

This chapter address a number of areas that will affect the lives of people as they age or people who are older adults. Philosophical paradigms, statistics, evidence-based approaches, dealing with the media, making people aware of new technologies, and preparing for communities to best deal with issues of aging are all major issues of concern. It provides a range of issues; however, the chapter provides an overview of the most significant ones to be addressed or to require intervention. It cites 10 major challenges that the future will bring, in reality, policy advocates will have to be prepared to address and deal with these challenges by using innovative strategies for policy development and policy change. The chapter addresses policy development and program design to meet the needs of an aging and ability-challenged society are unique challenges.

This chapter helps the reader to be familiar with the role coalitions play in advocacy and policy development and to understand the various types of coalitions that affect the policy landscape. It also helps the reader to be familiar with the various roles that exist within groups and coalitions that contribute to the success or non-success of the group process. A number of strategies can be used to develop initiatives to impact one’s advocacy efforts. These strategies can be used to promote the development of new programs and services and can include the use of and/or development of coalitions, the media and media advocacy, and consumer advocates. The chapter addresses each of these strategies in greater depth. It outlines a variety of issues related to coalitions, group development, and coalition building for aging policies and programs.

This chapter briefly discusses the history of the Caregiver Support Act and its specific components and explains how the Caregiver Support Act provides resources to older adults and people with disabilities. It provides an overview of the current status of family members serving as caregivers, with special attention to grandparents raising grandchildren. It then discusses a current profile of relative caregivers raising children in the United States; reasons for the increase in relative caregiving; and issues facing grandparents raising grandchildren. It also provides some background into the literature and promotes an awareness of issues that grandparents face as primary caregivers. A literature review examines some of the current issues and services needed. The chapter discusses resources and services designed to meet the needs of grandparents raising grandchildren, and reviews programmatic responses through the national resources. Finally, the chapter outlines some best practice interventions for review in the text.

This chapter explores health promotion frameworks, to showcase their role vis-à-vis health policy and programs, and discusses three specific frameworks. Health promotion frameworks are theoretical conceptions of how health behavior can be addressed. These frameworks are conceives for the purpose of program and policy development. The health promotion frameworks are the health belief model (HBM), the theory of reasoned action, the transtheoretical model of stages of change. This chapter addresses these three questions; however, prior to discussing these questions and answers, it is essential to understand some well-known health promotion frameworks. Although a number of health promotion frameworks exist in the literature. It focuses on three that can be specifically applied to older adults. The chapter showcases use of health promotion frameworks in the program planning process for older adults can have a number of positive outcomes.

This chapter briefly discusses the history of the Affordable Care Act (ACA) and community and presents specific components of the ACA in relationship to community prevention. The chapter deals with specific aspects of the legislation that impact older adults and people with disabilities. It presents a short review of the ten titles: Title one: quality, affordable health care for all Americans; Title two: role of public program; Title three: improving the quality and efficiency of health care; Title four: prevention of chronic disease and improving public health; Title five: health care workforce; Title six: transparency and program integrity; Title seven: improving access to innovative medical therapies; Title eight: Class Act; Title nine: revenue provision; Title ten: strengthening quality, affordable health care for all Americans. The chapter explains some of the legislative highlights, policies, and programs that have been articulated within each of the specific titles of the ACA.

This chapter helps the reader to understand the history of the Elder Justice Act (EJA). It provides specific components of the EJA and how programs and services flow for older adults and people with disabilities. The chapter discusses the limitations in programs and services within the EJA. The EJA requires the oversight and the appropriation of federal funding to protect people growing older and people with disabilities from abuse. It addresses legal issues with a special emphasis on the concept of a power of attorney. The chapter explores several legal issues that face older adults. It also address elder abuse, power of attorney, and a differentiation made between the types of power of attorney and the healthcare power of attorney. In addition, the chapter explores legal services provided to older adults as a result of the Older Americans Act, and outlines the challenges within the realm of legal issues.

This chapter provides a backdrop to our current social security program and an overview of some models for social security programs in Europe and Canada. It explores the genesis of the social program in the United States. The chapter also explores contents of the original social security act (SSA) and compares the titles and programs mandated through the current SSA. It offers some guidelines for the current administration of the program, examines the debate around current proposals for revision, and reviews why these proposals are current issues for consideration. The chapter then presents the current social security system, which provides for older adults, but has also grown to cover dependent women and children. Although many people have argued for their vision to privatize the system, the reality is that there is much more political support to maintain the program as a safety net program rather than a means-tested program.

This chapter helps the reader to be familiar with the demographic and social factors that influence and shape aging and disability policy over time and to be aware of policy changes over the past century within disability and aging public policy. It explains the contrast between advances in science and technology and public policy related to people growing older and people with disabilities. Landmarks serve as essential tools to help us recall specific historical events in time. Historical landmarks, science, and technology have played significant roles in the evolution of social policies; however, aging and disability policies may not have made as many strides as other areas throughout history. The chapter briefly discusses: the role of historical landmarks in shaping social trends and public policies; the relationship between historical landmarks and aging and disability-related policies; and trends in policy, social, and political influences and landmarks in the United States.

This chapter helps the reader to understand the history of the Americans with Disabilities Act (ADA), specific components of the ADA and how the ADA provides resources to older adults and people with disabilities. The ADA, while groundbreaking, was not initially intended for people with disabilities rather than for older adults. As time progressed, however, the benefits of the ADA were much more far-reaching than originally intended, especially for aging adults with disabilities. The individual titles of the ADA have had some dramatically positive and specific impact for older adults wishing to remain in their homes or in their communities as long as possible. Although the ADA is still in its young adulthood, the benefits of the ADA have only grown as new and further linkages, such as the ADRCs, have developed in all regions of the United States.

Disruptive, impulse-control, and conduct disorders include conditions involving problems in the self-control of emotions and behaviors. Unlike other cases in this book, the two cases highlighted in this chapter are unique in that these problems are manifested in behaviors that violate the rights of others such as aggression, and/or that bring the client into significant conflict with societal norms or law enforcement. Questions for consideration follow each case.

Dissociative identity disorder (DID) is usually a reaction to trauma as a way to help a person avoid bad memories and is characterized by the presence of two or more distinct personality identities. This chapter highlights the detailed case of an adult woman diagnosed with DID. The case offers an in-depth description of the client’s identities and takes the reader on a journey through her treatment. Questions for consideration are also included.

Depressive disorders are characterized by sadness severe enough or persistent enough to interfere with function and often by decreased interest or pleasure in activities. This chapter contains three cases of depressive disorders in adults, including major depressive disorder and dysthymia. These cases illuminate how depression manifests in different people with different backgrounds, including a young Caucasian woman, young biracial man, and a middle-aged woman. While the clients in these cases have symptoms that lead to a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) diagnosis in the same category, the cases highlight how medical concerns may complicate symptoms, as well as family of origins issues that may exacerbate symptoms. Questions for consideration are also included.

This chapter includes a case on narcolepsy as experienced by a college-aged female. Narcolepsy is a chronic neurological disorder that affects the brain’s ability to control sleep–wake cycles. The client in this case felt rested after waking, but then feel very sleepy throughout much of the day.

Narcolepsy greatly affected the daily activities and may impact the future of the client who had hoped to be a typical college student. Questions for consideration follow the case study.

For a sexual problem to be considered a sexual dysfunction, the symptoms must be present for at least 6 months, cause significant distress, and cannot be caused exclusively by a nonsexual mental disorder (e.g., substance use, depression), significant relationship distress, medical illness, or medication. The three cases in this chapter represent various sexual dysfunctions, such as female sexual interest/arousal disorder and erectile dysfunction disorder, and their respective treatment. Questions for consideration follow each case.

While the occasional experience of anxiety is a typical part of life, people with anxiety disorders often have intense and persistent worry and fear about everyday situations. This chapter contains three cases of anxiety disorders in two adult males and one adolescent female. Generalized anxiety disorder is highlighted in this chapter as well as the less common, selective mutism diagnosis. While the clients in these cases have symptoms that lead to a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition) diagnosis in the same category, these cases highlight how cultural factors and family of origins issues may exacerbate anxiety-related symptoms. Questions for consideration are also included.

Feeding and eating disorders are characterized by eating behavior that results in health and/or psychosocial problems. This chapter includes two cases of diagnosed eating disorders—anorexia nervosa and bulimia nervosa. Anorexia nervosa is characterized by restrictive eating that leads to dangerously low body weight and disturbances in self-perceived shape or weight. Bulimia nervosa is a disorder that includes episodes of binge eating and compensatory behaviors (e.g., purging, exercising). Questions for consideration follow each case.

Bipolar disorder is a mental disorder that causes unusual shifts in mood, energy, concentration, and the ability to perform daily tasks. This chapter contains three cases of bipolar disorder in adults. These cases illuminate how the same disorder manifests in different people with different backgrounds, including an African American woman, a Caucasian man, and a young Caucasian woman. Discussions of intersectionality, substance use/abuse, and questions for consideration are also included.

Somatic symptom disorder is characterized by an extreme focus on physical symptoms (e.g., pain, weakness, fatigue) that causes major emotional distress and problems functioning. This chapter features two cases of somatic symptom disorder in two adult women. While their symptoms may not be traceable to a physical cause, they do cause excessive and disproportionate levels of distress and dysfunction.

Neurodevelopmental disorders are conditions that affect the functionality of the brain. With many neurodevelopmental disorders, the signs and symptoms most often begin to show when a child is young, usually around preschool years. This chapter follows this pattern and includes three cases of neurodevelopmental disorders in children, including attention deficit hyperactivity disorder and autism spectrum disorder. Family dynamics and school considerations are also included with these cases given the ages of the clients. Questions for consideration are included.

Schizophrenia is a chronic, severe mental disorder that affects the way a person thinks, acts, expresses emotions, perceives reality, and relates to others. While uncommon as compared to other mental disorders, it is often the most chronic and disabling. This chapter contains three cases of schizophrenia spectrum disorder and other psychotic disorders, including delusional disorder of two types. These cases highlight disorders that cause various degrees of distress and dysfunction in three adult males. Questions for consideration are included.

Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics. The cases in this chapter include two cases of adolescent gender dysphoria. In the first case, the adolescent is considering future transition against the backdrop of family acceptance and cultural issues while the other adolescent highlighted in this chapter has transitioned and manages depression and a history of child abuse. Questions for consideration follow each case.

A paraphilic disorder exists when recurrent, intense sexually arousing fantasies, urges, or behaviors cause distress and/or impairment to the individual. In some individuals with paraphilic disorder, their sexual satisfaction has entailed personal harm or the risk of harm to others. The cases in this chapter represent studies of sexual sadism and voyeuristic disorder and how each of the men diagnosed with these conditions respond to court-appointed therapy. Questions for consideration follow each case.

Obsessive-compulsive disorder is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). This chapter contains three cases of obsessive-compulsive and related disorders in three adolescent males. While the clients in each of these cases have symptoms that lead to a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition) diagnosis in the same category, this chapter highlights how the disorder often presents in different ways and with different obsessive thoughts (e.g., sexual orientation obsession). Obsessive-compulsive disorder may co-occur with Tic disorder and a case that demonstrates this link is included. Questions for consideration are also included.

The misuse and abuse of substances such as alcohol and drugs put people at risk for short-term and long-term harm. This chapter highlights the cases of four individuals and one family who have diagnosed substance-related disorders such as alcoholism or opioid addition. Questions for consideration follow each case.

Personality disorders are a type of mental disorder in which individuals have a rigid and unhealthy pattern of thinking, functioning, and behaving. The three individual case studies presented in the following chapter have trouble perceiving and relating to situations and people, causing significant problems in relationships, social activities, and the workplace.

Trauma and stressor-related disorders are a group of emotional and behavioral problems that may result from traumatic and stressful experiences such as exposure to physical or emotional violence or pain, including abuse, neglect, or intense family conflict. This chapter contains five cases related to trauma and stressor-related disorders including posttraumatic stress disorder, acute stress disorder, reactive attachment disorder, and adjustment disorder. The clients in this chapter also includes a broad range of ages and demographics, ranging in age from 8 to 68, and they are urban, rural, and suburban dwellers with a variety of family constellations, strengths, and challenges. Specific traumas related to child sexual abuse and neglect as well as questions for consideration are also included.

Race, ethnicity, and culture influence client identity and life circumstances. Other factors, such as gender and gender identity, sexual orientation, age, socioeconomic status, religion, and ability may also play into the context of a client’s mental health or personal issues. The four cases in this chapter feature cultural aspects that have a significant role in the treatment and conceptualization by their clinicians. Culturally competent clinicians practice cultural humility and understand that clients’ backgrounds influence the ways in which they view the world and that the clinician’s role must change to accommodate these perspectives.

The elimination disorders in this chapter involve the inappropriate elimination of urine or feces and are the result of trauma in a midlife female and an adolescent male. This group of disorders includes enuresis, the repeated voiding of urine into inappropriate places, and encopresis, the repeated passage of feces into inappropriate places. Questions for consideration follow the case conceptualizations.

This chapter features five cases from across the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and may be used as a final review. There is diversity in clientele, diagnosis, and treatment modality and may help students demonstrate their skills in diagnosis and treatment of mental health disorders.

Neurocognitive disorders describe decreased mental function due to a medical disease other than a psychiatric illness. In this chapter, cases related to substance-induced major neurocognitive disorder and major neurocognitive disorder due to Alzheimer’s disease are presented. Questions for consideration follow each case.