This chapter focuses on the following topics: demography, gender, age at diagnosis/onset of cardiovascular disease (CVD), Medicare usage, work and retirement, social support, social context and neighborhoods, ethnography of families, qualitative research, and social policy. These topics constitute some of the key areas that should be the focus of future research on the sociology of minority aging. The chapter provides a rich description of trends in the ethnic and racial composition of older cohorts to illustrate the dramatic changes that have taken place in the United States in the past century. The rising costs of health care and the increasing older minority population, additional reform will be needed to maintain the sus-tainability of the program. Additional work examining within-race group differences is key to understanding minority aging issues given the large amount of cultural diversity in the United States.

Neurorehabilitation has become more of a global phenomenon and is not necessarily limited to industrialized or Westernized societies. Culture often connotes concepts of race and ethnicity when discussed in the context of health care disparities. Socioeconomic and other demographic variables make up the majority of the balance on discussion regarding culture in health care. Multicultural neurorehabilitation must emphasis “multiple”, and do so in a dynamic manner. In other words, at any given time, multiple cultures operate in each interaction and in each therapy delivered in the neurorehabilitation setting. Recently, there has been increased interest and research into the newly developing field of cultural neuroscience. Several models are available to conceptualize the influence of culture in human functioning. The most persuasive model is one that mirrors a dynamic, ecological system.

This chapter focuses on aging and health issues in all of America’s major minority populations including African Americans, Hispanics/Latinos, Asian Americans, as well as Native Americans. It addresses the issues of health inequality and health advantage/disadvantage. The chapter introduces relatively new areas of inquiry including long-term care, genetics, nutrition, health interventions, and health policy issues. In addition to possible genetic factors, the literature has emphasized the influence of poverty and socioeconomic status as well as stressors associated with minority group status. The system of long-term care services will need to be restructured to take into account issues affecting minority populations such as health care coverage, housing and income supports, as well as cultural issues as filial piety and trust. The field of minorities, aging, and health has been dominated by a health inequality perspective that has been illustrated by the application of cumulative disadvantage/cumulative inequality theory.

This chapter focuses on the changing health care policy climate. These changes can either reduce current barriers or create new challenges to health care. The Patient Protection and Affordable Care Act (ACA) has reformed the Medicare payment system and incorporated the voice of older minority adults in shaping the performance of their local health care delivery system. Health care access inequity and policy-based remedies have historic roots in U.S. civil rights legislation. The civil rights of older adults and their access to health care were resolved through Medicare. ACA policy creates an opportunity to reframe health disparities research as a consumer issue. However, the terms health disparities, older minorities, and barriers to care are not usually viewed as consumer issues. Standardization of health care practice creates research opportunities for social gerontologists to evaluate policy and its impact on health care access disparities.

This chapter provides a review of public policy and public programs related to important aspects of the welfare state in the United States, with particular attention to the impact of various policies and programs related to income support, health care, and housing on low-income and minority Americans. It focuses on the guiding principles that motivate the various parties in today’s welfare state debates and investigate how the basic structure of the way social welfare is guaranteed in the United States affects low-income and minority individuals. The chapter also focuses on the general features of our economic, political, and social systems that place minority Americans at serious risk of poverty and ill health throughout life, including its waning years. The welfare state represents a relatively late development in human social, economic, and political history. Social Security is particularly important for minority Americans.

This chapter emphasizes the importance of improving health literacy. It describes the incorporation of cultural competence standards in forensic social work practice perspectives. The chapter also explains how to promote engagement of informal support networks in promoting health and well-being among diverse groups. Disadvantaged racial and ethnic minorities in the United States have long been overrepresented in the criminal justice systems. The elimination of health care disparities and ensuring the health care delivery system is responsive to minority groups is a social justice issue. The roles and function of forensic social workers that provide services to persons with these cultural norms can be expanded using a broader ecological framework and the applied social care model to develop intervention strategies and care plans with incarceration persons. Identifying and incorporating culturally appropriate practice approaches are challenging, yet necessary undertakings for forensic social workers.

Nonprofit, for-profit, and hybrid organizations with the greatest impact in areas such as education, health care, and social service delivery could also create new social industries and spur economic development. Angel investors are often the first professional lenders who provide financial support to a growing business. Launched in the United Kingdom, social impact bonds (SIBs) raise funds from nongovernment investors, that is, trusts and foundations, high-net-worth individuals, and so forth, to pay for preventive services. Greater levels of funding will be directed to organizations next-generation nonprofits (next-gens) that can prove impact and take operations to scale. This chapter discusses two very different innovations that are also sustainable business models, the retail-based convenient care clinics (CCCs) and the Apple iPad2. CCCs operate under different names, including Minute Clinic, Redi-Clinic, Take Care Health Systems, and Quick Quality Care. The Disrupter-o-Meter is an excellent, low-cost place to begin determining an innovative idea’s feasibility.

This chapter focuses on how nonprofit leaders can become nonprofit advocates. It provides an overview of the legal guidelines that govern nonprofit lobbying. The chapter details the process of developing a policy agenda, learning the legislative landscape, and executing the agenda. It reviews the tactics of effective lobbying, such as working in coalitions, meeting with lawmakers, and cultivating relationships with legislative allies. The chapter then presents case studies that describe the advocacy process that went into the expansion of the role of nurse practitioners as primary care providers and the expansion of the retail-based convenient care clinic model. It explores case study that discusses an assessment process on which advocacy for college access and success systems change can be built. The chapter examines how nonprofits can shape legislation by lobbying elected officials in ways that are in keeping with the Internal Revenue Service’s (IRS) definitions and requirements.

Sexual abuse can create sensitivities and problems that infiltrate a person’s sexuality years after the actual trauma occurred. A Guide for Survivors of Sexual Abuse provides basic information and recovery strategies for helping survivors of military sexual trauma (MST) overcome the repercussions of abuse and establish healthy and pleasurable sensual lives. Sexual healing tends to be more advanced recovery work. Sexual behavioral changes often seem to fall into two extremes, withdrawing from sexual activity, or becoming compulsively drawn to engaging in it. Victims of MST may have a challenging time finding enough private space, social support, and safety to face what happened to them and begins healing. Initial recovery tasks, such as dealing with fear of the offender, overcoming depression, expressing anger, improving physical care, improving assertiveness skills, and coping with posttraumatic stress symptoms are fundamental to sexual abuse recovery.

Field education is an integral aspect of every social work student’s training. Whether a student is obtaining a bachelor’s degree in social work (BSW) in the hope of pursuing a career in generalist practice or working toward a master’s degree in social work (MSW) to prepare for advanced or independent work, learning skills and practice techniques in community settings is essential. The work that is performed by students in the field is supervised by social workers in many different organizational and practice settings. The relationship between the field instructor and the social work student provides fertile ground for socialization as a member of a profession and the acquisition of practice skills. Whether we are working in health care, child protection, mental health services, corrections, education, gerontology, or another area of social work practice, we have much important knowledge to share with a student.

This chapter deals with major health care issues that social workers need to be familiar with in working with immigrants. It provides an introduction to the many complex, interconnected issues that social workers and their immigrant clients face as they navigate the US health care system in an attempt to obtain quality health care. The chapter focuses on some of the implications for social work practice that arise from public health issues and provides discussion questions and several case studies. Social workers can and should be vigilant in advocating for increased translator and interpreter services at their agency or medical setting, not just for the convenience of the patient, but for his or her safety and improved health. Social workers in the field of health care must actively address the issues of language, culture, and income/health insurance status as well as legal status when working with immigrants.

This chapter provides a theoretical background for Medical Family Therapy (MedFT) as the systemic approach to integrated care as well as unique considerations for supervision in the integrated care settings where MedFTs typically practice. It consists case example to offers a frame and illustration for the application of this important approach. MedFTs master the elements of a traditional mental health intake to assess any psychopathology, history of past treatments, use of medications, family and social history, and relational dynamics that influence the exacerbation or maintenance of individual, relational, and/or health problems. In integrated care settings, a course of treatment typically unfolds episodically because the patients and their family members will have onsite access to return to psychotherapy when the need arises again. For most MedFTs, clinical care and supervision occur in an integrated health care setting.

Housing communities for older adults are not a contemporary concept. The guiding concept of creating older communities is the desire to give older adults an alternative concept of housing that will allow them to sustain themselves economically, while giving choice and an element of control over their health care, social networks, and physical environment. Many older adults choose retirement communities for an added sense of personal security and continued independent living as a beginning preparation for their ultimate mortality. Aging in place encompasses an older adult staying in his or her home throughout the aging cycle or moving to housing that provides limited services such as an option for communal dining, cleaning services, and transportation. Like aging-in-place strategies, continuing care and assisted living facilities provide medical and nonmedical living services to older adults who are unable to live independently because of medical illness, cognitive decline, or disability.

Supervision activities in the early stages are likely to be highly structured and prescriptive and require close monitoring of skill development, as supervisees are more likely to be anxious and more dependent on their supervisors. Supervisors can help trainees to explore new school psychological roles, focus on professional behaviors that will help them gain independence, and develop a repertoire of self-care strategies. Supervisors may also support trainee role expansion by assigning new activities and responsibilities, particularly in National Association of School Psychologists (NASP) domain areas that are underrepresented in current practice. Supervisors can also assist supervisees in becoming more independent by encouraging them to take risks and maintain a healthy perspective about their work in the field. Practicum supervisors can support trainee self-care with two key activities: monitoring and modeling their own professional self-care, and encouraging supervisees to develop their own set of self-care strategies.

The process of assessing an older adult occurs on two levels. The first level takes place when an older client presents for assessment. The second level of the assessment process is used for gathering facts that are analyzed for diagnosis, treatment planning, and disposition. Most social workers treating older adults will be younger than their clients. Therefore, clinical authority and respect may become an issue. It is common to treat older adults experiencing hearing deficits who have trouble perceiving high frequencies. The social worker must evaluate the status of the client’s housing, transportation, food, clothing, recreation opportunities, social supports, access to medical care, kinship, contact with neighbors, and other environmental resources that the client or social worker considers important. During the collection of this data, the opportunity will arise while discussing social relationships to collect historical information on the client’s psychosocial development.

This chapter explores the challenges that chronic disease presents to health care and introduces systems medicine and the emerging disciplines of genomics, epigenetics, and neuroscience. It highlights the importance of patient education and behavioral therapy with respect to key modifiable lifestyle domains. The chapter describes the integration of mindfulness into chronic disease care. Systems medicine is an approach to viewing chronic disease as distinct from acute disease and recognizes the complex interconnectivity of the various systems of the body. Furthermore, systems medicine views chronic disease as lifestyle triggered, influenced by nutrition, physical activity, thoughts and emotions, relationships, and even sleep and relaxation. The chapter explores the basic characteristics of the brain-mind-body connection and how this knowledge can be useful for behavioral health with respect to chronic disease. It also explores the basics of psychoneuroimmunology as an example of this interconnectivity and the consequences of system imbalances.

The YMCA of the USA’s partnership with United Health Group (UHG) was particularly innovative, and it was based on sound principles that can effectively guide even the most informal partnership efforts. Leaders from the participating nonprofits were eager to understand how they could position their organizations to establish formal partnerships with health care entities. By sharing facilities and resources, the partners intend to collaborate on programs, provide better access to services, and use financial and volunteer resources most effectively. The North Penn Community Health Foundation (NPCHF), an independent, private foundation, has supported the collaboration through strategic funding for visioning and organizational, legal, and fundraising planning and support as well as collaborative program development. Partnerships and collaborations are fostered and encouraged to promote learning and creative problem solving and to leverage the core competencies and resources of collaborators who seek to address unmet community needs.

Substance users have substantially reduced rates of use of preventive health care services, and reduced rates of compliance with prescribed medical treatment. Primary care providers are frequently overwhelmed and may be reluctant to address substance-related problems given few resources. Direct collaboration with a behavioral health specialist (BHS) co-located within the primary care clinic results in increased efficiency and better treatment outcomes. There are excellent resources available for the BHS who will provide tobacco abuse interventions in the primary care setting. A number of behavioral factors should be considered in effectively addressing substance use and abuse in the primary care setting. Primary care providers should also be alert to unexplained vague symptoms, somatic complaints, difficulty with sleep, anxiousness, frequent life disruptions or chaotic lifestyle, and a family history of mental health problems or substance abuse.

This chapter explores many trends that will influence the trajectory of health care delivery for the foreseeable future, and how each of these trends can assist in people’s endeavor to manage medical trauma. In mental health, mindfulness is a component of a number of distinct therapies, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT), as well as the foundation of approaches, such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT). Telehealth has become an integral part of the health care landscape and is continually building on the use of technology in everyday life. Interprofessional education (IPE) is a key to breaking down the silos of the health care and mental health professions, which is critical if we are to successfully manage the psychological impacts of medical trauma. In the end, managing the psychological impacts of medical trauma is a shared responsibility.

This chapter provides an overview of the medication issues and concerns mental health practitioners will encounter. The philosophy of the authors is simple: collaborative teamwork between physicians, prescribers, nurses, other health care providers, and mental health practitioners such as social workers is necessary for ethical and competent practice. Social workers make up the majority of mental health professionals in the United States. The chapter offers both historical and current perspectives on the importance of the knowledge of medications used in competent professional practice. From a social work perspective, it encourages an interdisciplinary team approach that takes into account the client's environment; thus, special attention is given to empowering clients to become active participants in the treatment process. The approach also recognizes the social worker as an important member of the health care delivery team. Psychopharmacology, medication as a primary treatment modality, and psychotherapeutic approaches are discussed.

This chapter sheds light on how the managed care system works as well as the counselor's role in managed care and the importance of advocacy and issues related to payment and reimbursement. It offers a starting point to understand the system, and counselors must continue to seek more resources, join organizations and build networks with other counselors and change makers to become active members of the professional community. Managed care is an integral part of the healthcare system, and it is imperative for counselors to be able to understand the system in order to navigate it better. Counselors can anticipate the issues that are related to cost and payments and can provide more efficient service to the clients, if they understand how managed care system operates. The chapter demystifies the issues of payment for counseling services, specifically third-party billing, managed care, medical assistance programs, and other issues therein.

This chapter explores the diversity of professionals engaged in pastoral counseling, the characteristics of those professionals within the ever-expanding landscape of mental health care, and the settings in which pastoral counseling most often occurs. It describes the plurality present within the discipline, summarizes the discipline’s use of the adjective pastoral, and offers a broad, fluid understanding of pastoral counseling. Pastoral counselors at the center of practice in the 1950s to 1970s may have claimed to speak in a singular tongue and envisioned a monolithic tower representing the theory and practice of the discipline. Pastoral counseling is an approach to mental health care that draws on the wisdom of psychology and the behavioral sciences alongside spirituality/religion/theology. Pastoral counselors are bicultural because they have graduate training in both religious/spiritual/theological education and a mental health discipline. Religiously endorsed pastoral counselors are, like all pastoral counselors, bilingual and bicultural.

This chapter offers an overview of the profession of Clinical Mental Health Counseling (CMHC) and illuminates some of the relevant dynamics that underlie the practice of CMHC. It presents content that links the practice of CMHC with the importance of an ecological perspective of the individual and to the current landscape of integrated healthcare. The chapter offers a foundation for understanding the individual from a bioecological perspective, as well as for appreciating the delivery of mental health services from more contemporary community-based and systems-of-care models. It provides a brief description on: contemporary counseling ethos, human ecology and systems, professional and therapeutic tensions and dynamics, and relevance of understanding the council for the accreditation of counseling and related educational programs standards. By focusing on a preliminary orientation to current CMHC concerns, trends, settings, and practice-based issues, the chapter provides an impressionistic picture of contemporary CMHC.

This chapter focuses on using the skills of the social worker to support the health care delivery team. In order to complete the advocacy and broker functions basic in the field of social work, an accurate assessment and referral process in regard to medication use must be utilized. As part of the assessment process, a medication history needs to include the client's patterns of medication use, preference, and potential for (or history of) abuse. Every record must have basic information, including the date and time of entry, interview notes describing the client and the problem or situation requiring treatment, an assessment and initial treatment plan, and therapeutic objectives and treatment responses. An accurate and responsible history should also explore the possibility of medication abuse. When the potential for abuse is high, social workers can prepare the team to be aware, thus avoiding possible problems for the client.

This chapter examines the development and organization of pastoral care within the context of managed care. It illustrates an approach that has been effective at engaging a medical system while providing quality care to patients. The chapter provides a potential plan on how to further establish a training program in the context of educational systems and licensing boards. Pastoral psychotherapists have historically been well educated and trained in diverse counseling and psychotherapy clinical theories and methodologies. The term pastoral in pastoral psychotherapy typically connotes a specificity of education, training, supervision, and experience. The Integrative Psychotherapy Training Program (IPTP) offers a useful model for how pastoral counseling and psychotherapy is self-differentiating while extending its influence into the complexities of a very large health care delivery system. When developing an integrative psychotherapy service center and training program, the program must discern the service needs of the health care system.

Chronic pain syndromes are composed of a multifactorial relationship between biologically based neurological triggers and pathways; psychologically mediated moods, emotions, and behaviors; and socially developed responses, interactions, and consequences. The complex interplay between these factors can devastate a patient’s quality of life, as well as make the diagnoses, treatment, and ongoing management of chronic pain syndromes by health care professionals exceedingly difficult, resulting in psychological and physical disability. In chronic pain, the imprinted signals and perceived pain may persist for several weeks, months, or even years after the original injury has healed. Treatment of chronic pain creates yet another dimension of complexity, as it requires a multimech-anistic, multimodal, or multidisciplinary approach for effective management. Chronic pain often is mixed nociceptive and neuropathic or primarily neuropathic and is associated with imprinted neuroanatomical and chemical changes in the peripheral and central nervous systems, which results in abnormal processing.

The goals of geriatric rehabilitation are to maximize function and minimize activity limitations and restrictions on participation in daily life for older adults. This is accomplished in a variety of settings including acute inpatient rehabilitation facilities, skilled nursing facilities, outpatient rehabilitation clinics, and the home of the older adult. It is common for older adults to have multiple co-morbid conditions such as diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease, pointing to the need for an individualized program with adequate precautions that minimizes the risk of injury to the person undergoing a rehabilitation program. This chapter sketches the description of the demographic changes facing the US population and the impact of these changes on the delivery of health care. A careful and comprehensive evaluation of the older adults is imperative to both identifying the clinical problems and subsequently determining the appropriate rehabilitation plan.

This chapter discusses integrative medicine utilizing the classification approaches devised by the National Center for Complementary and Integrative Health (NCCIH), and provides selected research findings regarding some of their most popular examples. It is no surprise to those in the modern medical field, that integrative medicine is indeed an enmeshed part of the fabric of health care approaches, whether we choose to accept them or not. It is also no surprise in the scientific communities that integrative medicine needs to continue being studied and researched to validate its integration into “mainstream medicine”. The term “integrative medicine” has been borne out of the scientific need to translate “non-conventional” health therapies and systems, to better serve modern society’s health care needs. It is no surprise that the main driver of increased use of complementary alternative medicine (CAM) derives from the demand of consumers of health care.

Health care has been transforming since its inception when public health issues were not understood, through epidemics and a plethora of infectious diseases, to today’s sophisticated medicine with its myriad levels of subspecialization. As the impact of illnesses transformed over time, so did the medical professions, the health care facilities, and the concept of insurance to assist in covering the rising cost of care. As a subset of telehealth, telerehabilitation has become a viable option for providers and payers to effectively manage rehabilitation care in the postacute environment. Although physicians are primarily focused on their clinical duty to their patient, payment methods clearly have an effect on care delivery. Examples of this, relative to bundled payments, could include the utilization of diagnostic imaging, frequency of physician office visits, inpatient length of stay, and the number of follow-up visits between hospitals and physicians.

This chapter breaks down eye movement desensitization and reprocessing (EMDR) therapy Phase 1, noting which elements of standard knowledge on EMDR history taking and preparation may need to be downplayed or amplified depending on the client or system in question. It covers some of the fundamental screening and assessment strategies used in addiction care. Most of these tools can be given without formal training in addiction and are used in universal healthcare settings like primary care medical offices. In the case of the CAGE (cut down, annoyed, guilty, eye opener) Questionnaire, even lawyers have been known to administer this to determine whether clients they are serving may be in need of medical intervention. The chapter explains that using EMDR therapy to treat addiction must involve more than just using specialty protocols. Comprehensive understanding of the person and their presenting issues is imperative. The chapter provides many ideas for adaptation and consideration.

Caring for the geriatric population can be a challenging endeavor, especially when considering the numerous issues that they may have to cope with on a daily basis. This chapter reviews the topic of medication adherence and describes several promising technologies aimed at improving such within the larger scope of medication therapy management (MTM). These tools at our disposal today greatly benefit our elderly population in particular, by better equipping them to manage their chronic health conditions and addressing their unique challenges. As improvements in adherence monitoring technology become more affordable and available, the business of health care will evolve into a more integrated enterprise between patients and their health care providers. Although the future direction and successful impact of many of these adherence technologies looks promising, they will only be possible if both medical and nonmedical professionals find ways to safely and effectively adopt them.

This chapter provides insight into the demographics of aging, and an overview of potential benefits and challenges of using technology to help older adults. It outlines four interconnected challenges of an aging population. With the expected increase in care needs that coincides with an aging population, the first challenge is the question of how to provide relevant high quality-care to older persons. Second, with fewer caregivers available in relation to the growing population in need, we can expect that the relative burden of care experienced by caregivers will increase. The third challenge is to increase the relative number of healthy and independent seniors by taking a more proactive approach with prevention and health maintenance strategies. The final challenge addressed concerns the development of health care systems and policy changes that are more inclusive of needed assistive technologies and medical devices.

Substance misuse, abuse, and substance use disorders constitute a major public health crisis in the United States. This places a tremendous strain on the nation’s healthcare system. Social workers are advocating for policy changes aimed at preventing and reducing the serious adverse consequences of substance abuse disorders. This chapter underscores the importance of addressing prevention and treatment with various population groups and includes the following three subsections: Practice, Research, and Policy for substance misuse, abuse, and addiction. The development of policies that support healthcare reform and treatment is vital for addressing the major public health crisis of substance use disorders. Social workers have played an important role throughout history in working with the complex problems of addictive disorders. The education and training of social workers and all healthcare professionals about the issues associated with addiction is critical to reducing stigma and providing competent and quality treatment services.

This chapter discusses the difference between medical models of disability and psychosocial models of disability. It addresses the environmental and psychosocial influences on relationships of individuals with disabilities and explains how people with disabilities can achieve and maintain optical health and functioning. The chapter describes the current health care systems in the United States and reviews alternative ways to improve weaknesses of the health care system. There are two ways to access to health care in the United States. The first is by having private health insurance purchased from a for profit health insurance company by your employer, yourself, or a family member. The second is by being eligible for Medicare or government-funded programs, most commonly Medicaid, the Veterans Health Administration, or the Indian Health Service. An organization of activist people with disabilities called ADAPT is dedicated to creating a priority on home-based services over institutionalization for people with disabilities.

The lesbian, gay male, bisexual, transgender, queer and questioning (LGBTQ) population is a diverse community that has historically been brought together to cope with an oppressive society. As society has become more accepting, younger sexual and gender minorities may feel safe and more comfortable disclosing their sexual orientation and gender identity. In order to understand the lack of attention and the healthcare needs of this population, social workers first must understand the LGBTQ community. In collaboration with their clients, social workers can develop goals to increase coping and problem-solving skills to help address stressors. By affirming the identity, expressions, and behaviors of sexual and gender minorities as equal to heterosexuals, men, and women, social workers can employ the various practice methods of research, policy, advocacy, leadership, and direct practice to empower LGBTQ persons and help them achieve equity in healthcare.

Healthcare in the United States is more of a patchwork quilt than a system of care. It is complex, diverse, and rapidly changing. One of the few constants across all healthcare sectors is assessment. This chapter defines the purpose of assessment, briefly describes key concepts in the bio-psychosocial-spiritual (BPSS) assessment, identifies and describes visual assessment tools, and introduces a family technology assessment tool. It highlights the intersections between policy, research, and practice. The chapter serves as “headline news” to essential topics and augments our understanding of assessment in healthcare settings. Social workers are expected to include a spiritual assessment in the traditional biopsychosocial assessment. Technology assessments in healthcare and mental health continue to be an underutilized tool in providing state-of-the-art evaluations. The development of a technology ecomap provided an example of a visual technology assessment aimed at digital inclusion in family systems evaluation.

While high-income nations have experienced increasing life expectancy as a consequence of better healthcare and healthier lifestyles, this does not mean that the size of the aging population will be the highest globally. The issue of HIV and older adults will continue to be a public health issue across the globe and will require the attention of factors related to socioeconomic context as well as sexual health and education. Regardless of the income of specific nations, families provide essential and important support for elders. The support of the oldest-old and those who require long-term supports and services earlier in life will be the most pressing issue for all nations going forward—rich and poor alike. These issues, in and of itself, is a great reason to participate and learn about international issues and global aging so that we can in fact face the challenge of change in our aging world.

This chapter defines disability in an international context and compares global disability issues in high-resource and low-resource countries. It discusses the relevant disability demographics, constructs, and resources that relate to global perspectives of disability issues and the expanding role of rehabilitation counselors (RCs). According to the UN, comparative examinations of disability-related legislation indicated that “only 45 countries have anti-discrimination and other disability-specific laws” thereby highlighting the urgent need to advocate for disability-friendly policies worldwide. These important issues relate directly to theoretical perspectives on disability, definitions of disability, and the role of RCs. The chapter addresses the awareness of current global contextual factors and other issues affecting disability such as culture, poverty, trauma, crisis, large-scale disaster, HIV and AIDS, and psychosocial issues across the life span. The WHO has published guidelines for community-based rehabilitation (CBR), including a matrix that covers the five components of health, education, livelihood, social dimension, and empowerment.

A dramatic shift has occurred in the field of long-term care in recent decades in how providers talk about those they serve. This chapter explains what consumer rights are and suggests how they might apply in long-term care. It considers obstacles that older consumers with physical and cognitive disabilities may face as well as barriers imposed by the markets themselves, such as the failure of healthcare to respond to market forces that are supposed to drive prices down and lead to new and improved products. It acknowledges the special rights of users of medical care, nursing homes, assisted living facilities, and health plans as articulated in patients' rights and residents' rights declarations and agreements. The chapter finally makes the case that consumers' rights should be a component of elder justice and that elder justice advocates and the public need to understand how to exercise and protect them.

Throughout history, social work has played a significant role in the changing healthcare delivery system. This chapter highlights the history of healthcare and social work, including the roles social workers are engaged with diverse populations. It underscores the unique contributions and challenges that social workers are involved with in practice, policy, and research. Social workers have advocated for human rights and social justice throughout history. Social workers can help to change the healthcare delivery system that embraces collaboration with the individuals, families, communities, and other disciplines to insure good health for all members of society. Social workers recognize the dignity and worth of all people as well as the influence of the environment on human life. The recognition of healthcare disparities that continue to exist in society is a major concern of social workers responding to the needs of vulnerable populations.

Over the past 10 years, the U.S. healthcare system has undergone substantial changes, impacted by the Patient Protection and Affordable Care Act (2010), and motivated by the need to improving healthcare quality and outcomes, while reducing costs. Healthcare delivery system changes have included integrating behavioral healthcare into primary care diverse populations groups, older adults. SAMHSA-HRSA Center for Integrated Health Solutions delineated a specific set of competences for Integrated Behavioral Health and Primary Care. These competencies are the following: interpersonal communication; collaboration and teamwork; screening and assessment; care planning and care coordination; intervention; cultural competence and adaptation; systems-oriented practice; practice-based learning and quality improvement strategies; and informatics. The need for integrated healthcare driven by the poor outcomes and high costs prevalent throughout the U.S. healthcare system has led to significant changes in service delivery, particularly in primary care settings.

This chapter focuses on the concepts of personalized medicine in relationship to wearable technology. It begins by reviewing the technical foundations of wearable devices, including sensor technology, big data, and the Internet of things (IoT). Next, the chapter looks at the benefits, challenges, and limitations of wearables in health care. Finally, it presents specific case scenarios in which wearables have been, or could be, advantageous to an older population, applications in clinical research, the role of regulatory agencies, and the future direction of wearables in medicine. Wearable devices show great promise for aiding the development of personalized medicine, particularly home-based use case scenarios for the older adult. There are numerous requirements for creating successful wearable solutions including aesthetic design, mobility, connectivity, and data analysis. Obstacles and limitations are a reality, but technology companies, universities, and governments are working to surmount issues such as accuracy, security, and engineering.

Social work values and ethics continually guide policy, practice, and research in the healthcare field. Using the lens of social work values, this chapter begins with examining social work policies and government policies on healthcare. Identifying ethical challenges and dilemmas and applying a model of ethical decision making for practitioners will also be addressed. The chapter ends with the need for continued research on ethics to enhance social workers’ understanding of this important area. Social workers in the health field in the United States are often impacted by health issues of those around the world, such as the increasing number of immigrants and refugees that access healthcare and the concern that deadly new viruses such as Ebola and swine flu are only a plane ride away. Thus social workers need to have a global perspective in addressing health concerns.

This chapter explores how the transformation of the health care system in the United States has impacted service delivery of health care disciplines including rehabilitation counseling in providing the most effective clinical services. It provides a review of key evidence-based practice, knowledge translation, and research utilization concepts. It discusses how evidence-based practice can be utilized to improve the professional practice of clinical rehabilitation counseling. The chapter explains how the mechanisms of theory development, empirical evidence, and clinical application inform practice in vocational rehabilitation (VR) service delivery, improving evidence-based practice to enhance outcomes and quality of life (QOL) of people with disabilities. The development of a systematic research agenda and conducting meaningful theory-driven research and intervention research will generate new knowledge and accumulate high-quality evidence, enhancing the ability of rehabilitation counselors (RCs) to truly engage in evidence-based practice to improve employment outcomes and QOL of people with disabilities.

Treating illness at home is a tradition that has recently been revitalized by a number of factors. Specifically, telecommunication tools, financial imperatives, quality initiatives, staffing constraints, and patient preference are among the leading drivers for this transition. Successful telehealth program outcomes depend on a number of issues, with knowledge, leadership, and management being paramount. Home telehealth programs hold the potential to improve patient outcomes with cost-effective, patient-centered care. Home telehealth programs offer an appealing cost-effective alternative or extension to acute, subacute, and long-term care centers, or nursing home facilities. Developing effective, cost-effective, value-based, patient-centered alternatives requires a redesign of many fundamental aspects of health care delivery. Home telehealth programs hold great promise in facilitating this critical paradigm shift in health care, and success depends on interrelated factors, which are well illustrated in the context of the Triple Aim. The Triple Aim is a framework developed for improved population health.

Robert Butler coined the term “ageism”. Butler described ageism in three realms: stereotypes and prejudices against older adults, discrimination against individuals, and institutional practices and policy that disadvantage older adults or perpetuate discrimination. He believed that ageism accounts for disregard for older people's rights seen in public policy. He saw it in the failure of institutions to address the needs of older people or protect their rights, citing as evidence government's failure to protect older people against mistreatment or to enforce nursing home regulations. He saw it in the lack of attention to older people in disaster preparedness plans and in the institutional ageism that leaves many older people impoverished and vulnerable. Although Butler and others saw ageism as standing alongside other “isms” other forms of injustice and discrimination it never achieved their traction. This chapter explores why. The chapter discusses elder abuse, ageism in healthcare, workplace, and public policy and politics.