It is important to have a thorough understanding of the neuroepidemiology of central nervous system disorders to incorporate cultural diversity into the neurorehabilitation care of patients with these disorders. This chapter emphasizes traumatic brain injury and stroke two of the most common neurological disorders seen in neurorehabilitation facilities and services. It begins by reviewing existing neuroepidemiological studies that include representative samples of individuals from different cultures. The study of traumatic brain injury has seen a clear evolution in the sophistication, breadth, and depth of findings concerning neuroepidemiology as it affects racial and ethnic minorities. As large-scale epidemiological studies increasingly include and distinguish individuals of color and linguistic minorities together with religion, sexual orientation, physical disabilities, place of residence, and key socioeconomic variables that interact with race/ethnicity, more information will be available to make changes in policy, training, and clinical service delivery.

The multicultural movement in counseling and psychology has begun to provide scholars and practitioners with contextually relevant, systems-based ecological approaches to counseling as alternatives to the traditional theoretical models of human behavior and intervention that are based on Western dominant culture. This chapter provides awareness of the complexity of multicultural issues among individuals with disabilities and discusses culturally sensitive strategies to work with people with disabilities (PWDs). It reviews legislative mandates related to diversity and multiculturalism in rehabilitation and addresses the relationship between disability and culture in the scope of rehabilitation practice. The chapter introduces multiculturalism and multicultural counseling models as a therapeutic framework and provides guidelines to help psychologists increase their cultural sensitivity. It also provides strategies to work with individuals with disabilities from minority backgrounds.

Neuropsychological assessment involves the administration of a battery of tests that assess a variety of cognitive domains to obtain a clinical picture of brain behavior relationships. Within the inpatient rehabilitation setting, neuropsychologists often perform various functions, including neuropsychological assessment, psychotherapy, and assistance with adjustment issues for patients and their families. This chapter discusses some of the common cultural issues that impact neuropsychology in an inpatient rehabilitation setting. It focuses on potential sources of bias that can threaten the validity of neuropsychological tests. The chapter also examines the process of the neuropsychological evaluation within the inpatient setting when working with individuals from diverse cultural backgrounds. It deals with a complex composite of sociodemographic factors that include education, socioeconomic status (SES), race, ethnicity, language, and worldview, all of which interact with one another to influence brain-behavior relationships.

This chapter explores multicultural variables to consider when providing neurorehabilitation services to inpatients in an acute neurorehabilitation center. It presents case studies of inpatients who have recently suffered brain injuries, strokes, and other conditions that have led to acute and/or chronic disability and potential cognitive changes. The acute and/or chronic disability and potential cognitive changes are in need of physical, occupational, and speech therapy to address declines in functioning due to cognitive changes and physical disability, as well as medical treatment to manage secondary conditions. The chapter then looks at several cases that involve clinicians working with patients and families from diverse backgrounds and of varying English-speaking abilities. It examines how culture, education, religion, and language may affect the clinical evaluations of patients in acute neurorehabilitation settings and at a clinician’s experience in providing multicultural neurorehabilitation.

Cultural beliefs have a tremendous influence on a person’s perception of disability. Viewing culture as a discrete system that encompasses interconnected components should enhance the cultural competence in rehabilitation centers. The manifold layers of culture include the: culture of origin, mainstream culture, brain injury culture, therapists’ culture, and the culture of the neurorehabilitation program. With the increased emphasis on cultural sensitivity, health care training programs have been focusing on enhancing the cultural sensitivity and competency of health care providers. These health care provider aspects also very much apply to the therapists in neurorehabilitation settings. The milieu-oriented neurorehabilitation program creates a unique culture that is different from other cultural influences encountered by an individual. Neuropsychologists in the Center for Transitional NeuroRehabilitation (CTN) milieu program play an important role in fostering a culturally sensitive and competent interdisciplinary team and in translating cultural considerations into concrete treatment approaches and goals.

This chapter explores the impact of acculturation on three diverse U.S. populations: Hispanics, represented by a specific focus on Mexican immigrants; African Americans; and Native Hawaiians. It reviews relevant acculturation theories developed to explain cultural and psychological changes occurring in racial and ethnic populations in the United States as a result of interactions with the majority racial/ethnic population. The chapter presents Berry’s model of acculturation in particular, as a helpful theoretical model for clinicians working in neuropsychological rehabilitation to use for understanding psychological issues related to acculturation pressures. It also highlights the unique historical context of acculturation for each ethnic group and its effect on their acculturation experience as well as mental and physical health outcomes. The chapter provides rehabilitation psychologists and counselors with culturally relevant assessment and intervention recommendations for working with ethnically diverse clients.

This chapter examines disability identity as a unique area in which the clinician working with individuals with brain injuries must become culturally competent. It begins with an overview of the disability rights movement and its influence on disability identity as a construct. Legislative and regulatory scaffolding for societal responsiveness to and acceptance of individuals with disability exists, but it requires further refinement. Social agencies have been created to support the process of adaptation to disability culture and are attempting to foster development of disability identity through networking resources for employment and socialization. The chapter then discusses critical issues in cultural competence and how these intersect with ethical practice in working with individuals and families with neurorehabilitation needs. It concludes with suggestions regarding cultural competence that transcend individual diagnoses.

This chapter explains the importance of using a certified medical interpreter and how to appropriately use this service in a hospital setting. An interpreter needs to understand cultural beliefs and be able to effectively communicate the information between two individuals who are likely from different cultures. The trained and culturally sensitive medical interpreter can communicate verbal information and serve as a cultural bridge between two individuals who could have very different beliefs about everyday interactions with others. Culturally competent medical translators pay close attention to both the verbal nuances of language and the nonverbal norms and customs that may be significant in a health care interaction. The chapter also discusses the importance of patient perception on follow-through of treatment, the idea of cultural competence, and how to appropriately communicate and use interpreter services. It provides some case examples of successful and unsuccessful interpretation.

Rehabilitation providers who work with service members and veterans face significant cultural challenges that may impact the rehabilitation process. Part of this challenge is maintaining an awareness that any individual engaged in rehabilitation could have had prior military service that could impact rehabilitation care. This chapter provides an overview of military culture, including specific aspects of this culture that may affect the rehabilitation process, the various co-occurring disorders that are common in military/veteran populations, and resources and programs that are particularly useful when working with service members and veterans. Service members and veterans face unique challenges and stressors that are over and above some of the routine sources of stress that others face in the workplace. Stress can come from participating in combat, including exposure to traumatic events, risk of injury, and fears about deployment.

This chapter explores the concept of microaggressions in neurorehabilitation settings, describes their potential impact on the rehabilitation process, and offers recommendations on how to address and potentially mitigate infractions when they do occur. It illustrates different types of microaggressions that might transpire in neurorehabilitation settings. Providers in these settings may benefit from cultural competency training to develop a greater appreciation for how microaggressions may impact the quality of their work with ethnic minorities, detract from the working alliance, and limit therapeutic success. Increased familiarity with factors that might contribute to microaggressions may help providers better identify them and intervene in a timely and therapeutically helpful manner. However, given that a defining feature of microaggressions is their unintended nature, neurorehabilitation and other clinical settings would be well advised to establish policies that encourage critical self-examination and dialogue regarding specific issues of race, ethnicity, and culture without fear of harsh reprimand.

This chapter describes spirituality, religiousness, and indigenous/folk belief systems in a multicultural context. The majority of religion and health research to date has primarily focused on persons with life-threatening diseases and conditions, as persons facing death may use religion to help them accept their condition, come to terms with unresolved life issues, and prepare for death. In contrast, rehabilitation patients who suffer acute injuries or chronic progressive disorders may live for decades after the onset of their condition and use religious and spiritual resources to help them cope with their disability, give new meaning to their lives based on their newly acquired disabilities, and help them to establish new goals. The chapter then explains the different ways rehabilitation psychologists can address religious and spiritual beliefs with individuals from different faith traditions.

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 a snapshot of current immigration patterns and a profile of the US immigrant population. It discusses the impetus behind immigration. Immigration is not only a current national issue. Given the great diversity and myriad needs of the growing immigrant population, it is essential that social workers understand the legal and political as well as psychological and social issues surrounding immigration. Chain migration is a process of movement from immigrants’ homelands that builds on networks of familiar social relationships to construct neighborhoods or communities within the places of habitation, which reflect the cultural norms and societal expectations of the homelands. Social workers who work with immigrants need to understand the personal immigration history of their clients in order to best help them. At many schools of social work, students have learned to view immigrant issues through a human rights lens.

This chapter discusses legal methods that noncitizens can use to enter and stay in the United States (US) for a long term. US immigration law sets out a variety of ways in which noncitizens can enter the country legally. When confronted with a noncitizen client, service providers may want to ascertain how the person first entered and what immigration status the person is in now, as a way to later determine a legal remedy. However, knowing the legal classification and method of entry will help the service provider in understanding the legal as well as social service needs and aid the provider in making referrals to immigration specialists as well as other places that could help with the client’s needs. For noncitizens entering the US who are already recognized as refugees, the service provider’s role is perhaps most relevant in providing mental health counseling.

This chapter focuses on some culturally sensitive and competent ways to serve immigrant clients by examining what is meant by cultural competence in social work practice and how this applies to work with immigrant populations. It examines the institutional arrangements that contribute to ongoing racism and xenophobia and the kinds of responses needed to help integrate immigrants into the fabric of American society. Culturally competent social work practice (CCSWP) is an ethical responsibility for all social workers and an absolute necessity when working with immigrant populations. The social work profession has been very concerned about defining and preparing practitioners to engage in culturally competent practice. Learning to be culturally competent practitioners is not only important for professional social workers but also needs to be incorporated into the education of future social workers. Cultural competence begins with administrative support and encouragement, quality supervision and oversight, strong peer relationships, and manageable caseloads.

This chapter addresses theoretical and conceptual resources for practice with immigrant populations with the intention of identifying conceptual frameworks and ideas that can serve as guides to assist in the development of practice orientations and skills, which meet the multifaceted needs of immigrants and their communities. It discusses assumptions about the role of theory as well as implications for skills and interventions. The chapter discusses theories and concepts that can frame practice with immigrants, beginning with themes and issues currently discussed in the sociopolitical context and the American sensibility about how to respond to immigrant presence. Overreliance on factors related to individual behavior risks blaming the victim, which can result in social workers colluding with a largely unresponsive and unreceptive environment. Theories that promote an understanding of the sociopolitical context of immigrant populations, as well as linguistic and cultural competencies, are essential for effective social work practice.

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 explores the definition of mental health as a culturally prescribed concept with special emphasis on the topic of strength-based and resiliency-focused assessment. It discusses the complexities of psychological assessment with new immigrants as well as the determination of appropriate levels of intervention, including specialized treatment options. Culturally and linguistically appropriate therapeutic services and models will increase the effectiveness and efficaciousness of mental health treatment. A major mental health vulnerability in new immigrant populations is often the variety of traumatic experiences that has forced these individuals into the role of immigrants. Personal crisis, including any psychological/addictive symptoms experienced, should be addressed immediately by the mental health professional. The primary relationship between immigrant clients and mental health practitioners should be created and maintained. In initiating mental health interventions with immigrant children, it is ideal to engage the caretakers and complete family system in order to ensure treatment compliance and success.

Each year, the United States (US) Department of Homeland Security removes hundreds of thousands of people from the US. Increasingly, the federal agency tasked with removing noncitizens has prioritized removal of those who have had contact with the criminal justice system. Those who are not citizens of the US may face additional consequences related to their immigration status, such as ineligibility to adjust their status to that of lawful permanent residents, inability to travel abroad, ineligibility for US. citizenship, mandatory detention in an immigration facility, or removal. The three primary sections of immigration law affecting noncitizens charged with crimes are grounds of inadmissibility, grounds of deportability and good moral character. Further complicating matters for noncitizens, immigration consequences may be triggered absent a final disposition of guilt in a criminal court. Civil practitioners are invaluable advocates to immigrants and refugees who encounter the criminal justice system.

This chapter focuses on a profile of low-wage immigrant workers. It explains the rights and remedies available to immigrant workers under labor laws and explores the conditions and factors that lead to their abuse and exploitation. The chapter illustrates the barriers that prevent employers from enforcing labor and employment laws, including lax enforcement of laws by government agencies, the threat of deportation by immigration agents, and government programs that hinder workers from exercising their rights. Immigrant workers will be essential to keep the economy strong, to serve as caretakers for the aging population, to contribute to existing health care and Social Security systems, and to help shape the future of the Unites States. Despite government safeguards and nonprofit advocacy, the unfortunate reality for many immigrant workers is that violations of labor and employment laws by their employers are rampant, particularly in low-wage industries.

The children of immigrants can be today’s science competition winners and tomorrow’s entrepreneurs, nurses and doctors, teachers, homeowners, and taxpayers. This chapter discusses ways in which social workers can help families get their children into school and obtain the educational services they need. The main focus is on public elementary and secondary schools, although the chapter includes some discussion of other educational alternatives. Education laws and policies vary from state to state; policies, indeed, vary even from school district to school district. It is true that many important aspects of educational system, such as school age and attendance requirements, residency rules, course requirements, and graduation criteria, are governed by state and local laws, rules, and policies. Parents have important rights and responsibilities in the educational system of the United States. Yet it is well known that parental participation can make a tremendous difference to a child’s education.

This chapter examines violence against women in immigrant and refugee communities, including the particular dynamics, risk factors, and consequences of violence against immigrant women. Immigrant and refugee women experience domestic, sexual, and other forms of violence in ways that are both similar and dissimilar to that experienced by women who are born in the United States, including those from marginalized communities. Women fleeing abusive situations, from female genital mutilation to domestic violence, may be able to claim protection under the Refugee Act, claiming fear of persecution based on their social group their status as women. Social workers, in collaboration with other service providers and immigration attorneys, can assist women who have been victims by helping them put together the evidence required to prove a case of abuse that may ultimately result in lawful permanent residence.

This chapter reviews the history of how US immigration laws have treated lesbian, gay, bisexual, transgender (LGBT) newcomers, why sponsorship by a same-sex partner may still not be an option for some, how LGBT people may be able to apply for asylum, issues related to transgender immigrants, challenges facing newcomers, and challenges facing social work providers. Anti-LGBT persecutors rarely have a nuanced understanding of how sexual orientation and gender identity are related. LGBT newcomers face unique challenges in accessing the social service system, beyond the universal hardships of language barrier and culture shock. The biggest challenges facing practitioners in social service settings include knowledge of the law and cultural competence. Social workers affiliated with religious or ethnic institutions may be viewed warily by LGBT people, especially if those communities perpetuated discrimination or persecution against them in their home country.

This chapter provides an overview of sociodemographics of older adult immigrants as well as the current social work scholarship on issues, assessments, and interventions related to older adult immigrants and their families. The sociodemographics of older adult immigrants in the United States (US), defined by the US Census Bureau as foreign born and 65 years of age and older, is shaped by immigration policy. The largest numbers of older immigrants who arrive in the US are female, many of whom are widowed, with low educational levels and impaired physical functioning. Understanding the eligibility of older adult immigrants for government benefits and services must go hand in hand with increasing the cultural competency of social workers and social service, physical health, and mental health agencies. Older adult immigrants who require nursing home services, as well as their families, may be concerned about the cultural sensitivity of the nursing home environment.

This chapter focuses on eligibility and other rules governing immigrants’ access to federal public benefits programs. The major federal public benefits programs have always prevented some non-US citizens from securing assistance. In determining an immigrant’s eligibility for benefits, it is necessary to understand not only the federal rules but also the rules of the state in which an immigrant resides. However, many federal agencies have not specified which of their programs provide federal public benefits. The confusion stems from the complex interaction of the immigration and welfare laws, differences in eligibility criteria for various state and federal programs, and a lack of adequate training on the rules as clarified by federal agencies. Immigrants’ rights advocates, health care providers, and state and local governments organized to persuade federal agencies to clarify the limits of the laws. Federal agencies have worked to reduce the chilling effect of status-related questions on benefits applications.

This chapter explores advocacy tools for the social worker community, whether acting as individuals, volunteers, and/or members of social service organizations. It discusses the importance of advocacy work for social workers engaged with immigrant clients. The chapter focuses on individual and micro advocacy strategies. It provides the advocacy tools for effecting long-lasting and systematic policy change around immigrants’ rights. Practicing social workers can invite local agencies and community members to train their chapters on everything from new ordinances or policies affecting local immigrants to react to events like raids, hate crimes, and civil rights violations. Advocacy organizations were realizing that systematic change at the government level could not occur without educating, organizing, and empowering the underrepresented to vote and elect good leaders. Whether acting as individuals, groups, or through advocacy organizations, social workers must rise up on behalf of their clients and the communities they serve.

This chapter explores vicarious trauma, compassion fatigue, and burnout and the potential impact on professionals who treat victims of military sexual trauma (MST). Professionals who provide counseling to sexual trauma survivors will be affected by the exposure to the personal and, sometimes, graphic accounts of sexual victimization reported by their clients. Although brief exposure to extreme or shocking trauma material can have a significant impact on the helping professional, prolonged exposure to emotional pain and the explicit details of other people’s suffering can be more problematic. Psychologist Jacob Lindy pointed to this concern in his book on treating war veterans with posttraumatic stress disorder (PTSD). Burnout was originally used in the 1970s by psychoanalyst Hebert Freundenberger in reference to occupational exhaustion. Burnout may involve psychological, physical, or behavioral symptoms in both personal and professional settings.

Establishing rapport, building therapeutic alliance, and establishing and maintaining healthy boundaries are all important therapeutic skills especially when working with victims of military sexual trauma (MST). Along with being caring psychotherapists, clinicians may be called upon to play a key part in third-party issues, such as legal issues including custody battles or in reporting on clients for MST Department of Veterans Affairs (VA) service-connected disability benefits. This chapter reviews psychotherapeutic issues that arise when treating those with MST, specifically, barriers to treatment, establishing trust and rapport, boundaries, third-party issues, and documentation. The issues that prevent MST survivors from seeking mental health treatment mirror problems that service members may have had in reporting it, including fear of blame and stigma. To protect clients and therapists alike, it is also important to be mindful of other common boundary testing by trauma clients.

This chapter provides an overview of the nonprofit organization in the United States, the main characteristics of nonprofit organizations, and the reality of the nonprofit sector today. It describes the differences between a nonprofit and a for-profit corporation. Nonprofit organizations have existed for many centuries, especially through religious groups or religious-based activities. The nongovernmental sector is growing throughout the world. Increasingly, these organizations are playing key roles in the economic and social contexts of their countries. Unlike private-sector organizations concerned primarily with making a profit, nonprofit organizations are focused on carrying out a specific public-service mission. Successful nonprofit organizations require substantial capability in key areas of management: developing strong boards of directors, recruiting and motivating talented staff and volunteers, creating plans to focus resources on relevant goals and innovative programs, winning the support of diverse stakeholders, raising funds, and wisely managing fiscal and human resources.

This chapter explores the dimensions of financial sustainability as well as the principles needed to manage a nonprofit organization that can generate continuous funding through diverse sources in order to support its vision and mission in a way that is socially and environmentally sustainable. Sustainability is the ability of a business, an organization, or a project to fulfill its vision and mission, meet its goals, and serve its stakeholders over time. The chapter discusses the inherent, collateral, and environmental factors of financial sustainability in nonprofit organizations. Inherent factors of financial sustainability include: Financial management, budget, financial statement analysis, financial sustainability plan, social enterprise, fund-raising, grant seeking, investment, and risk management. Collateral factors of financial sustainability include: Governance, leadership, and strategic planning. The chapter describes key indicators that can reveal whether an organization is financially sustainable or is on the path for financial sustainability.

This chapter discusses the legal and organizational roles of the board of directors and special committees in the governance and financial sustainability of a nonprofit organization. It describes the differences between governance and government, and identifies some common governance theories. Corporate governance is often analyzed around major theoretical frameworks. The most common are agency theories, stewardship theories, resource-dependence theories, and stakeholder theories. The chapter highlights the key governance structures and perspectives in nonprofit organizations and lists some key principles of nonprofit governance. Governance models or approaches are considered in an eclectic perspective that combines empirical observations and literature related to nonprofit and for-profit organizations as micro societies. Eclectic perspective considers nonprofit board governance through functionalism, structuralism, structuro-functionalism, and symbolic perspectives. The chapter explores conceptual and theoretical frameworks that explain governance in nonprofit organizations in the context of financial sustainability.

This chapter explains the concept of needs assessment and the relationship between the individual and the community. It identifies the different steps involved in conducting a needs assessment and shows how needs assessment can contribute to the financial sustainability of a nonprofit organization. The chapter emphasizes how financial sustainability is rooted in the investigation and analysis of the needs of a target community. It discusses the theories about the needs-assessment process, as well as action steps toward the development of a community needs-assessment report. The chapter explores facets of financial needs-assessment of a nonprofit that can help chart a course to further the vision and mission statements. It helps the readers to learn how to use primary and secondary data to conduct a targeted needs assessment that is linked to the financial sustainability of a nonprofit organization.

This chapter focuses on the asset-based approach to community development. It provides the different types of assets that create opportunities for a nonprofit organization, describes the asset-mapping process, and explains the relationship between asset mapping and financial sustainability. The chapter introduces the theories, concepts, and approaches of asset mapping as a strategy to help nonprofit organizations identify obvious and hidden assets within their communities, and mobilize them to connect issues and needs with assets, and foster the financial sustainability of a nonprofit organization. It examines the community context of nonprofit organizations in relation to community groups, neighborhoods, and larger social systems that influence quality of life. The chapter includes the concept and theory of community capacity, models of asset-based development for building community capacity, empowering individuals and groups, generating funding from new sources, and creating additional paths toward financial sustainability.

This chapter describes the key phases of the strategic-planning process and ‘strengths, weaknesses, opportunities, threats’ (SWOT) analysis. A generic strategic-planning process includes three key phases of assessing, visioning, and strategizing in order to further the mission and vision of an organization. The vision, mission, and values statements constitute the core identity of a nonprofit organization. In other words, a nonprofit organization justifies its social or community relevance through its vision, mission, and values, and the extent to which they are reflected in governance and program implementation. The chapter discusses the relationship of strategic management and program effectiveness, and the interrelationships between strategic planning and financial sustainability. It introduces various approaches to effective strategic planning geared to the financial sustainability of a nonprofit organization.

This chapter introduces the concept of financial sustainability in relation to the use of financial statements. It also introduces selected financial ratios to assess the profitability, liquidity, solvency, efficiency, and effectiveness of a nonprofit organization. Profitability is the surplus of revenue over expenses. Profitability used to be a forbidden word in the nonprofit world. Many nonprofit organizations are faced with the challenge of undercapitalization and do not have enough cash or liquidity to pay their regular bills. The liquidity of an organization can be measured by the current ratio, the net working capital, and the acid test or quick ratio or liquidity ratio. Solvency is different from liquidity because it deals with the long-term ability of an organization to continue to exist and expand. The debt ratio and the debt-to-equity ratio are two common measures of organizational solvency.

This chapter describes a financial sustainability plan and explains the importance of a financial sustainability plan for nonprofit organizations. It discusses the elements of a financial sustainability plan. A financial sustainability plan should include an executive summary, financial sustainability analysis, financial ratios analysis, strategic goals and objectives, action plan, benchmark and outcomes, continuing quality improvement strategies, and budget. Many nonprofit organizations are faced with a constant challenge to match financial sustainability with their vision and mission statements. Some of the challenge may have to do with how much money they can successfully raise. This aspect can be manipulated by greater fund-raising efficiency and effectiveness. The chapter suggests approaches and best practices in developing a financial sustainability plan for a nonprofit organization. It includes a step-by-step process to use to develop a financial sustainability plan.

The term “fund-raising” can be used for any activity whose primary purpose is to raise money to support the activity of a nonprofit organization. The meaning of the term “fund-raising” can change based on approaches used by a particular nonprofit organization. This chapter discusses why people donate to nonprofit organizations. The literature suggests that people donate to nonprofit organizations based on compassion, altruism, values, tax deductibility, corporate social responsibility, stewardship, and solicitation. The chapter identifies some common effective fund-raising strategies used by nonprofit organizations in the United States and describes the items in a fund-raising proposal. An effective fund-raising proposal requires effective planning. The planning of fund-raising activities should start with a fund-raising proposal that sets clear justification, goals, objectives, and overall approaches and strategies. Finally, the chapter provides conceptual frameworks and approaches to organize fund-raising activities that can generate alternative funding for financial sustainability.

This chapter describes the concept of social enterprise and explains the term ‘social entrepreneurship’. The term ‘social enterprise’ refers to a business activity intended to generate profit to finance a social, educational, cultural, religious, or charitable cause. A social enterprise is a for-profit business whose primary purpose is to reinvest its profits in not-for profit activities. There can be various types of social enterprises such as small-business entities, co-operative, social firm, credit union, trading arm to charity, and public sector spin-outs. The chapter explores the steps needed to develop a social enterprise and describes the key components of a business plan. The development of a social enterprise requires an investment, which implies some costs. The costs will be fixed and variable. The chapter emphasizes social entrepreneurship as a mission-driven enterprise and a strategy for financial sustainability in nonprofit organizations.

This chapter describes the concept of investment and the items in an investment policy statement. Investment is the purchase of a financial or real asset by an individual, an organization, or an institution, in order to generate a return over time, which is proportional to the risk assumed during the investment period. The chapter identifies the different types of investments available for nonprofit organizations. The most common types of investments are short-term investment vehicles and fixed-income securities. Contrary to short-term investments, long-term investments are made with funds that are not needed for use in a period of less than a year. Examples of long-term investments are pension funds, self-insurance funds, and endowment funds. The chapter explains the extent to which investments can contribute to financial sustainability of nonprofit organizations. It summarizes the key principles for investment management and examines the management structures involved in investment for nonprofit organizations.

This chapter defines the term “grant” and examines potential funding sources for nonprofit organizations. A grant is a monetary fund disbursed by an institutional or organizational donor to a recipient, which does not have to be paid back. The chapter discusses the overall grant-seeking process and describes the items of a generic grant proposal or application. A grant proposal is a written document or application submitted in response to a call for proposals issued by a grant-maker agency or as a result of opportunities for funding or an invitation received by an applicant. A generic grant proposal includes: cover letter, cover page, table of content, abstract, problem or needs statement, goals and objectives, project description, timeline, organizational capability, evaluation, references, budget, and appendices. The chapter focuses on how grant seeking can serve as a strategy to generate revenues that may ultimately contribute to financial sustainability of a nonprofit organization (NPO).

This chapter defines the term “budget” and explains the importance of the budget for a nonprofit organization. It describes the different types of budgets and provides the most common budget approaches. The most common types of budgets are an operating budget, a cash budget, and a capital budget. The chapter also describes the process of developing a budget in a nonprofit organization and presents the relationship between the budget and financial sustainability in nonprofit organizations. Budget techniques are central to the successful operation of all organizations. A budget enables organizations to allocate scarce resources, control operations, and manage performance. A budget is the translation of an organization’s plans and priorities. The chapter helps the readers to learn the basic concepts and practices of budgeting in nonprofit organizations. It also explains the essential role played by budget approaches and techniques in the successful and sustainable operations of a nonprofit organization.

This chapter defines the concept of financial management and establishes the relationship between financial management and nonprofit financial managers. A nonprofit perspective on financial management includes financial planning, financial monitoring, financial decisions, and financial accountability in order to ensure that an organization can sustain its financial resources to fulfill its vision and mission through the achievement of organizational goals and objectives. The chapter discusses the various facets of nonprofit corporate finance and accounting and lists the most common funding sources of nonprofit organizations. It examines the financial and accounting principles and procedures related to the management of a nonprofit organization. The chapter addresses basic accounting principles that leaders of a nonprofit organization should be aware of, and the conditions surrounding the financial situation of a nonprofit organization. It describes a financial management system and explains the relationship between financial management and the financial sustainability of nonprofit organizations.

This chapter defines the concept of financial statement and introduces the generic structures or formats of three main financial statements: the income statement, the balance sheet, and the statement of cash flow. The income statement includes three major sections: The income or revenues, the expenses or expenditures, and the balance or summary. The balance sheet of a nonprofit organization includes three main sections: Assets, liabilities, and fund balance. The chapter establishes the differences between an income statement and balance sheet. It explains the sections of Internal Revenue Service (IRS) Form 990 related to the income statement and the balance sheet. The chapter explores the principles and procedures used to develop various financial statements and link them to the legal financial reporting requirements for a nonprofit organization. It helps the reader to gain experience with the basic terminology and tools to read nonprofit and public financial statements.

This chapter defines the concept of risk and discusses the mechanics of risk management. A risk is the potential for negative, unwanted, or unpredictable consequences from an event, an activity, or a decision. Risk management involves making and carrying out decisions for the organization that will minimize the effects of risk. The chapter identifies the common areas of risk for nonprofit organizations and presents various types of risks related to management of a nonprofit organization. It introduces the theories and practices of integrated risk management in relation to its contributions to the financial sustainability of a nonprofit organization. The chapter describes the nature and contents of a risk-management policy. Risk-management options refer to the decisions of an organization to take action or purchase insurance for the purpose of: Risk avoidance, risk reduction, risk retention, risk sharing, and risk transference. The chapter explains the relationship between risk management and financial sustainability.

This chapter defines the term “human resource management”. Human resources management is the set of managerial activities involved in planning, recruiting, motivating, retaining, and developing a workforce that can contribute to the efficiency, effectiveness, overall performance, and sustainability of an organization. The chapter describes a human resource management system and human resource information system (HRIS). A generic HRIS includes components related to personnel management, time and attendance, payroll, and benefits. The chapter defines “job satisfaction” and discusses various job satisfaction approaches and theories, staff turnover, and staff retention. Theories in job satisfaction will be examined with respect to content, process, and situational theories. The chapter explains the key roles of human resources management and job satisfaction in the financial sustainability of a nonprofit organization and also explains relationship between human resources and financial sustainability.

This chapter discusses the term “service delivery” and describes a service delivery system in the context of a nonprofit organization. Servitization is the process whereby an organization develops creative and innovative ways to create a product-service system that integrates value-based products and service offerings. The chapter discusses the roles of client-centeredness, decision making, scheduling, priority setting, effective and efficient flow of services or activities, quality assurance, and continuing quality improvement, and how these factors contribute in their own context to influence positively or negatively the financial sustainability of a nonprofit organization. A customer-centric service design is a service delivery system that focuses on providing the best quality service possible to customers or clients or the service target, based on a service concept, a service decision path, service sustainability, and service quality. The chapter explains the relationship between service delivery and financial sustainability.

This chapter defines the concept of program evaluation and also defines the term ‘logic model’. A program evaluation design is a document outlining principles and procedures to assess the achievement of a program’s goals. The logic model is one of the most common program design frameworks used in program evaluation. Program evaluation can be a needs assessment, a formative or process evaluation, a summative or outcomes evaluation, or an impact evaluation. The chapter identifies the items in a logic model and explains the benefits of a logic model for a nonprofit organization. It describes the process used to conduct a program evaluation and also explains the term ‘performance measurement in a nonprofit organization’. Program evaluation includes performance measurement to assess overall organizational effectiveness. The chapter examines the relationship between program evaluation and financial sustainability.

This chapter defines the terms community relations, outreach, and partnership in relationship to nonprofit organizations. Community relations combine an organization policy and process used to develop and implement community outreach and awareness about programs and activities in order to promote the organizational vision and mission in a community-oriented manner. As a policy, community-relations programs and activities are intentional. The chapter also defines the terms advocacy and public relations. Public relations involve the communication of intentional messages to the public in order to influence the opinion or perception of an organization by the public at large. Public relations are a key communication practice for organizations, including nonprofit organizations. The chapter describes the different facets of community relations and discusses community outreach, partnership, advocacy, and public relations as facets of community relations. It explains the relationship between community relations and financial sustainability.

This chapter explains the purpose and benefits of information systems for nonprofit organizations. Information technology refers to the means of access to information and related services that combine various support and devices, such as telephone, computer, software, and the Internet. Information technology includes all computer-based information systems and related technology used by organizations in the operation of their programs, activities, or services. The chapter discusses the dimensions of information systems and also discusses the most common types of information systems in organizations. Some organizations develop and maintain: executive information systems, management information systems (MIS), and transaction processing systems. Effective information system must meet at least five criteria such as accuracy, completeness, consistency, relevance, and timeliness. The chapter presents the relationship between information technology and the financial sustainability of nonprofit organizations.

This chapter defines the concept of social marketing and provides some of the common areas for the use of social marketing by nonprofit organizations. The term “social marketing” has been used for several decades to refer to a systematic process of using marketing strategy to influence current behaviors of a target population into a desired behavior in order to positively change a social or community issue. The chapter describes the contents of a social marketing plan. A social marketing plan is a document that justifies the needs for a social marketing campaign, as well as the process of implementation by outlining a SWOT (strength, weakness, opportunity, threat) analysis, a description of the target population, the goals and objectives, an impact statement, the marketing mix strategies, an implementation plan, an evaluation plan, and a budget. The chapter establishes the relationship between social marketing and financial sustainability.

This chapter defines the concept of leadership and describes the most common leadership theories. Most scholars agree that leadership is a key component of organizational effectiveness. The very range of definitions of leadership and the absence of consensual agreement between the definitions make the concept of leadership an issue in itself. The chapter examines leadership from various perspectives with an emphasis on the influence of particular leadership styles on the financial sustainability of a nonprofit organization. It integrates theory-based and practice-based approaches, and thus provides tools to better understand and influence the leader-follower dynamic in the nonprofit setting. Early leadership theories include: Great man theory, traits theories, behavioral theories, contingency theories, and attribution and charismatic theories. The chapter explains the relationship between leadership and community relations and discusses the role of leadership in strategic planning. It also explains the relationship between leadership and financial sustainability of nonprofit organizations.

This chapter discusses the life cycles of organizations and focuses on the life cycle of nonprofit organizations. Daft. R. L. argues that life cycle of an organization includes four stages: entrepreneurial, collectivity, formalization, and elaboration. Stevens. S. K. argues that nonprofit organizations evolve from vitality to regeneration, through seven stages, encompassing idea, start-up, growth, maturity, decline, turnaround, and terminal. The chapter identifies factors affecting organizational transformation process of nonprofit organizations and discusses the elements of an organizational transformation initiative. The organizational transformation of a nonprofit organization includes factors that are antecedent to the process and other elements that are part of the process. Organizational transformation is the consequence of other factors or elements, which must be taken into consideration in future plans of action. These factors include, but are not limited to, life cycles, internal environment, and external environment. The chapter explains the relationship between organizational transformation and financial sustainability.

Resilience is the capacity to bounce back—to face, manage, overcome, and be strengthened by adversity. Grandparenting represents a role that requires resilience. We tend to think that grandparents have meaningful relationships with their children and with their grandchildren. Grandparents must also adapt to a changing social and technological landscape, learning new rules for (grand)parenting, and developing an understanding of both changes in recommended child-rearing practices and new social challenges. In their relationship with grandchildren, grandparents may be raising grandchildren, living with them in a multigenerational home, or living apart from them and providing baby-sitting, financial assistance, or even no support to them or their parents This chapter reviews the conceptualization of resilience, then of resourcefulness, a specific indicator of resilience, and related grandparenting and family research to provide examples, context, and further considerations.

This chapter explores the experience of grandparents and grief by: the death loss of a grandchild; the loss of the traditional grandparent– grandchild relationship due to grandparents’ assuming primary custody of the grandchild; and the loss of emotional connection with grandchild due to separation. It begins by examining the current sociohistorical context of grandparenting, followed by discussion of relevant theories of loss. The chapter reviews research on grandparents’ various experiences of grief, and conclude with presenting models of intervention with recommendations for therapy. Grandparenting literature highlights the importance of focusing more on what is gained than lost from changes out of one’s control. In this spirit, this chapter focuses on the reintegrative aspects of grief, exploring authentic experiences of grandparents while highlighting mechanisms that contribute to the construction or reconstruction of a new sense of normalcy and hope for the future.

This chapter provides a thematic overview of the literature concerning relationships between grandparents and their adult children, with an extension to the emergent topic of greatgrandparents. An empirical example from multigenerational data set is provided that highlights the mutuality and interconnections that cascade down the lineages of four-generation families where all generations consist of adults. The chapter discusses the change and continuity in grandparent–grandchild relationships with respect to contact, communication, closeness, and conflict. It also discusses the care provided to and by grandparents. The chapter focuses on gender and cultural variation in relationships between grandparents and adult grandchildren. It describes the unique family position of great-grandparents and their relationships with great-grandchildren. Finally the empirical example is provided examining patterns of change in the salience of great-grandparent, grandparent, and parent role identities.

Given the many roles that grandparents play in lives of their grandchildren, policies can be critical factors in their support and in their familial relationships. This chapter explores key policies impacting grandparents and thus their grandchildren. It focuses on policies affecting kinship care, as grandparents face a multitude of issues that can impact both their own well-being and that of the children they are raising. As involved and committed grandparents may have been, their concerns are at risk of being ignored, as they must prove to court that their custody or visitation rights are in the child’s best interest. Among the most vulnerable are those who are raising their grandchildren on marginal incomes without adequate housing and healthcare, and who must deal with service providers insensitive to their concerns and needs. Finally, policies that address the needs of grandparents must provide a vital framework for strengthening both families and society.

This chapter reviews the grandparent–grandchild relationship when grandparents are healthy, when they contract chronic illness and are in need of care, and when they are in the process of dying. It includes the particular aspects of health because each has the potential to play an important role in the grandparent–grandchild relationship. For example, as some leisure activities require a certain level of physical ability, research on leisure and grandparent–grandchildren time together may reflect grandparents’ health. Finally, the cognitive health of grandparents may play a role in how grandparents and their grandchildren interact. The process of aging is associated with a broad range of unique and often simultaneous declines, including physical, cognitive, and psychological changes. As age-associated illnesses arise and develop there may be instances, although not common, where grandchildren are so involved in their grandparents’ life that they become a caregiver for their ill grandparent.

A gender-inclusive approach to studying grandparenthood can be enhanced by using a framework that combines elements of life-course, feminist, and critical perspectives along with the concept of ambivalence. Such a framework encourages researchers to examine the connection of larger social forces such as gender relations to the experience of grandparent–grandchild relationships over time. The inequality and contradictions that characterize institutional arrangements, such as gendered expectations regarding paid work and family responsibilities, are directly linked to the ways grandparents negotiate relationships with their children and grandchildren across the life course. This chapter outlines a conceptual framework for studying grandparenting in the context of gender relations. It applies to a critical review of the literature on grandparents. The chapter concludes by suggesting directions for future research.

This chapter provides an overview of clinical issues unique to grandparenthood and outlines specific approaches to clinical intervention that may be used to address these issues. Having a theoretical foundation for intervention is imperative, as theories provide the conceptual framework necessary for understanding the development and maintenance of grandparents’ presenting problems. Four major theoretical approaches to clinical intervention with grandparents are intergenerational, developmental, systemic, and problem solving theories. The chapter provides an overview of these major types of theories as a means of illustrating how different theoretical perspectives would differentially inform clinical intervention with grandparents. While interventions focused on grandparents continue to be underdeveloped relative to many other populations and family difficulties, common intervention approaches include providing grandparents with emotional and social support, teaching new skills, delivering information and resources, and promoting intergenerational engagement.

Despite the growing attention in the literature addressing the experiences of lesbian, bisexual, gay, transgender (LBGT) youth and family acceptance, few researchers are examining these experiences in the relational context of being a grandchild or how grandparent–grandchild relationships enhance or hinder LGBT grandchildren’s experiences, especially when grandchildren disclose their sexual orientation to grandparents. This chapter discusses the important theoretical lenses used to understand and aids the study of LGB grandparenthood and reviews the literature on LGB grandparenthood and when grandchildren identify as lesbian, bisexual, gay, transgender, and queer (LBGTQ). Perhaps more importantly to the advancement of the literature on LGB grandparenting, the chapter provides recommendations for future research on grandparenthood in the context of sexual orientation, and hopes that discussion is a call to action for family scientists, gerontologists, psychologists, and sociologists to closely examine grandparenthood when grandparents, grandchildren, or grandchildren’s parents identify as LGBTQ.

Adult education is available in many communities. These opportunities are welcome, although courses rarely focus on family relationships, the topic that has the highest priority among grandparents. An intergenerational strategy is lacking that would allow parents of grandchildren, and the grandchildren, to identify content they think could help grandparents understand younger relatives. This chapter describes the origins of grandparent education and a measurement tool that allows three generations to evaluate strengths, learning needs, and growth of grandparents. It briefly describes an inclusive plan to ensure grandparents living in care facilities have access to instruction, feedback on learning, and opportunity to engage in community service. The chapter respects for cultural differences based on identification of curriculum themes that match the uniqueness of particular populations. It provides a revised emphasis for adult education that focuses on family relationships, the topic with highest priority among grandparents.

This chapter addresses a metaframework for conceptualizing global grandparenting. With this metaframework, it suggests four primary domains that can be used to understand grandparenthood from a contextualized, global perspective: culture, familial and social roles, solidarity and intergenerational transfers, and sociopolitical factors. While some aspects of grandparenthood may be best represented by one domain, the nuances of global grandparenthood are truly captured in the intersections among the domains, such that each domain influences—and is influenced by—the others. Through examination of the unique combinations and intersections of these four domains, it is then possible to explain the similarities and differences in grandparent experiences across global contexts. The chapter presents each of the domains of our metaframework and highlight associated literature for the purposes of illustrating the global variation within that particular domain. It concludes with reflections on directions for future research.

This chapter addresses the nature of theories used to guide and interpret the multifaceted issues associated with grandparenting. Family theories help to conceptualize both micro- and macrodimensions associated with grandparenting, including how identities and relationships at the microlevel interact with opportunities and disadvantages linked to broader social structures at the macrolevel. The chapter elaborates upon four common assumptions shared by theories that address family phenomena: developmental, diversity, systemic, and processual. It briefly describes six major family theories—family ecological, family systems, life course, social exchange, family stress and resiliency, and feminist theory and intersectionality. The chapter provides examples from the recent empirical literature about how these theories have been used in grandparenting research. Finally, it suggests that a key challenge for grandparenting scholars is to develop more comprehensive theoretical perspectives that can accommodate the increasing diversity of experience associated with this intergenerational family tie.

The phenomenon of four-generation families has become more prevalent in recent years, reaching relatively high percentages in the oldest age groups. In Israel, as well in other developed countries, life expectancy has increased, and the phenomenon of four- and even five-generation families is more common. Many studies have examined the role and the significance of grandparenthood, and its contribution to the quality of life of both generations, the grandparents and the grandchildren. However, only few studies, most of them conducted in the United States, have examined the significance of great-grandparenthood, and the relations between great-grandparents and their great-grandchildren. This chapter describes the perception of the role and meaningfulness of Israeli Jewish great-grandparents: a comparison between the perceptions of great-grandparents and grandparents about their role and about their relationships with their great-grandchildren and their grandchildren, and its contribution to their quality of life.

This chapter aims to more fully develop the often-overlooked observation that the grandparent and grandchild relationship is a mutual one. It focuses on conceptual model of the grandparent–grandchild relationships that one developed based on a linked-lives perspective, on their lived experience, their past research, and a careful review of the existing literature. In this model, it show that grandparent proactivity and grandchild–grandparent mutuality are essential features of a constructively interdependent relationship. The chapter starts by introducing a new mutuality model of grandparent–grandchild relationships. It provides a brief historical overview of the evolution of literature on grandparent–grandchild relationships. The chapter reports on major empirical studies that address relationships between young or adolescent grandchildren and their grandparents. It offers an experiential context and humanize the discussion by adding some personal reflections regarding grandparent–grandchild relationships and mutuality across multiple generations of the author’s family.

This chapter explores content-specific, design-specific, and data-analytic issues in grandfamily and grandparenting research using four approaches: quantitative methods, qualitative methods, mixed-methods research, and emergent research designs. Existing grandparent research will illustrate best practices with inclusion of research issues specifically encountered by grandfamily researchers—for example, recruitment and retention concerns and legal/ethical issues when working with intergenerational groups. The chapter offers strategies to address age–period–cohort effects, and grandparent research designs at the intraindividual, grandparent–grandchild dyads, and grandparent–child–grandchild dyads in family system and societal or structural levels. It includes specific guidelines for reporting each type of research. The chapter concludes with new, cutting-edge approaches being used in grandparenting research and ideas for future research.

This chapter addresses nonfamilial intergenerational relationships that allow youth and elders to experience grandparent-like relationships when grandparents or grandchildren may not be available to each other. It begins with consideration of contemporary demographic, structural, and historical influences affecting availability of familial intergenerational relationships, such as delayed marriage and fertility. The chapter turns to theories addressing the imperative of intergenerational relationships, including among unrelated individuals. Theories focused on individual development, such as Erikson’s psychosocial theory, interpersonal relationships, such as social exchange theory, and community development, such as social network theory, are related to the potential value of nonfamilial intergenerational contact. The chapter concludes with recommendations for advancing nonfamilial intergenerational scholarship through research, practice, and policy. Beyond the young and old persons connected through nonfamilial intergenerational relationships, we aim to highlight why youth, families, and society need these relationships as well.

This concluding chapter discusses grandparenthood and provides a brief description about the book. In this book, authors have presented multiple perspectives bearing on a deeper, multileveled understanding of grandparenthood, including the cultural/historical, developmental, ecological, cultural and cross-cultural dimensions, as well as from a clinical/family systems perspective. It attempts to understand the current and changing nature of grandparenthood, including the impact of changing historical and interpersonal contexts as well as the diverse roles that grandparents perform in families. Indeed, families today are different than before. With the increase in longevity and life expectancy leading to greater expansion of research on aging and the family, coupled with the growth of the grandparenthood literature, it is clear from the chapters in the book. The chapter concludes with future directions.

This chapter describes how demographic trends at different points of the U.S. history shape grandparenthood for the three cohorts of grandparents in distinctive ways. It discusses how the classic demographic transition, characterized by the dramatic decline in both fertility and mortality, accompanied by improved health and wellbeing of middle-aged and older adults, has resulted in increasing overlaps between grandparents’ and grandchildren’s lives for younger cohorts. The chapter addresses how the second demographic transition, namely, trends of increasing marital instability, nonmarital fertility, and single-parent households, has made grandparents–adult children–grandchildren bonds more complicated than ever. Finally, it reviews the impact of the third demographic transition, that is, the growing racial/ethnic and nativity diversity of the U.S. population has led to a more heterogeneous grandparent population for later cohorts in terms of composition and grandparenting experiences.

Divorce, cohabitation, remarriage, serial romantic partnerships, and living apart together have been relatively common among these older age groups. Stepfamily research has expanded in recent decades, but most of the focus has been on younger stepfamilies, with primary emphasis placed on relationships between stepparents and stepchildren or remarried spouses. Initially, Ganong and Coleman identified three structural pathways to becoming a stepgrandparent: a younger adult could (re)marry a parent with young children or adolescents who would grow up to become parents themselves as adults; an older adult could (re)marry a grandparent; and an older individual’s adult child could (re)marry a person who brings to the union children from a prior relationship. Given that parents often tend to mediate the relationships among grandparents and grandchildren, it is not surprising that parents’ divorce affects grandparent–grandchild relationships. It is somewhat surprising that few researchers have examined divorce by grandparents.

Over the last decade, there has been tremendous growth in scholarly and professional interest in grandparents raising grandchildren. This chapter refers to grandparents who are raising their grandchildren as custodial grandparents and their families as grandfamilies. Despite the many negatives often linked to grandparent caregiving, such grandparents are dedicated to the welfare of their grandchildren, are resilient and resourceful in coping with the challenges of raising a grandchild, and must be understood in terms of the social–interpersonal, developmental, cultural, and policy-related contexts in which they care for grandchildren. Good physical health is also protective in nature for custodial grandparents, though not all research supports this conclusion. Relative to physical health, the mental health concerns of grandparents raising their grandchildren has received less attention. Life-span developmental theory emphasizes multiple antecedents of developmental change.

The chapter provides a brief summary on the demographic impact and trends regarding grandparents in the United States. It reviews the current knowledge and available evidence associated with grandparent practices and values among grandparents of diverse racial and ethnic backgrounds. The chapter encourages future research regarding multigenerational relations, grandparenting, and the development of culturally tailored interventions. It pays serious attention to the role of culture on the experience of grandparenthood and the provision of care to grandchildren. However, the chapter considers culture as the specific medium where the meanings and practices of relationships and interactions among grandparents, their adult children, and grandchildren develop at a particular place and time. The chapter considers grandparenting to be a developmental transition where cultural practices are part of the larger sociocultural ecological system.

This chapter summarizes much of what is known, from scholars across the world, about grandfathers: the nature of their roles, their involvement with grandchildren, the influence of culture, and the possible impact of such involvement on their grandchildren and on the older men themselves. Many factors have impacted the number and functional status of grandfathers. Over time grandfatherhood has been shaped by culture and tradition, social conditions, and attitudes to older men. In addition to the changing roles of grandfathers over time, grandfatherhood today is further mediated socially and culturally through ethnicity. The question arises: Why should grandfathers care? Although evolutionary theory may explain why grandmothers are involved with grandchildren, the evidence is missing or absent when it comes to grandfathers. A central feature of recent grandfather research has been a number of studies linking grandfather involvement with child well-being.

This chapter focuses on the clinical treatment of four impaired grandfamilies in rural areas. The approach and experience are similar to grandfamilies in urban areas, especially inner cities, but their social/economic situation may be more desperate and culturally enhanced, and with few resources. The first case study involves the treatment of a child from a toddler through his adolescent years the lens is on resilience. The second one looks at grandfamilies from a family systems approach. The third explores the impact of early trauma and transgenerational influences on the adult children and grandchildren. The fourth case study examines the role of the judicial system and the need for clinicians to advocate in the courts on behalf of grandfamilies. In all four of the cases, the chapter implements a holistic, but personalized, approach to mitigate the negative impact of substance- and alcohol-use disorders, family abuse, transgenerational effects, and cultural influences.

Professional competence refers to our ability to perform effectively within our professional role. As counselors, we are required to remain aware of our professional strengths and weaknesses and respond accordingly when counseling situations fall outside of our ability to be effective. Professional competence involves working with client populations for which we have been properly trained, maintaining training and education throughout our careers, and identifying and addressing personal experiences or internal problems that can affect our ability to be effective counselors. In this chapter, authors cover what it means to be professionally competent, how to recognize when we are exceeding boundaries of competence, and how to maintain competence throughout a professional career. Professional competence includes a host of complex situations and variables. Much of the research and writings on the topic of competence focuses on multicultural competence. Understanding individual differences in our client population is essential for maintaining professional competence.

The concept of boundaries is understood as a method of maintaining professional roles within the context of providing services. The intention of professional boundaries is to maintain a healthy and trusting relationship between the professional and the client. This chapter focuses on three typical dilemmas that occur within counseling relationships: (a) self-disclosure, (b) accepting gifts, and (c) inappropriate relationships. It reviews each of these dilemmas and walk through how the American Psychological Association (APA’s) Ethical Principles of Psychologists and Code of Conduct and that of the American Counseling Association (ACA’s) Code of Ethics can guide our ethical decisions. Professional boundaries are maintained through an awareness of the cultural and workplace norms, and internal dynamics that impact a counselor’s perception and experience of boundaries.

This chapter reviews two ethical issues which authors find challenging for any counselor, given their nuances: (a) understanding how worldviews may collide and (b) what happens when boundaries are crossed. It discusses the role of self-awareness in sound ethical decisions. The chapter reviews each of these dilemmas and walk through how American Psychological Association (APA) and American Counseling Association (ACA) can guide our ethical decisions regarding each of these dilemmas. Counselors cannot make sound ethical decisions devoid of individual and sociocultural contexts. In this chapter the authors reviewed that being culturally competent includes having self-awareness of our biases and assumptions, knowledge of those we work with, and our ability to adapt our skills so they are congruent with the people we serve. It is most important to be aware of our various areas of privilege and biases that may impact our ability to effectively interpret and respond to ethical dilemmas.

Social media is an amazing way to communicate with friends, colleagues, and family members across the world. Counselors have the right to participate in and benefit from this way of relating to others it would be unrealistic to think otherwise. This chapter focuses on counselors’ personal use of social media platforms and how their participation may result in ethical dilemmas. Social media has become, and likely will continue to be, an integral way in which people communicate. The potential to leverage social media for counseling-related purposes is promising. However, given the laws, rules, and ethical guidelines and standards that are still under development, counselors must proceed with caution, even when social media is used for professional purposes, and thoughtfully consider the risks and benefits. Given the interconnected, transparent, and discoverable nature of social media, personal use must also be thoughtful and deliberate.

This chapter reviews multiple vignettes that provide examples of complex ethical dilemmas involving client and colleagues. It focuses on three specific gray areas that pose dilemmas for counselors. First, and perhaps one of the greatest dilemmas, is how to tell the difference between actions that can be addressed informally vs. actions that require reporting to ethics committees. While discussing the importance of addressing colleagues’ behaviors, it is essential to develop the ability to receive feedback ourselves. Therefore, two additional gray areas arise. First, how do we proceed when workplace rules seem to differ from our code of conduct? Second, how should we proceed if the counselor engaging in unethical behavior is a supervisor or someone in a leadership position? The chapter reviews each of these gray areas and walk through how the American Psychological Association (APA) and the American Counseling Association (ACA) can guide sound ethical decisions.

Fibromyalgia or the fibromyalgia syndrome (FMS) is a chronic pain disorder characterized by fatigue, muscle pain, tenderness, and sleep difficulties. This syndrome is referred as “soft-tissue rheumatism”. Fibromyalgia is a disorder that intrudes upon the daily life of people and is a worldwide phenomenon. Fibromyalgia might also include other symptoms such as concentration and memory problems, labile mood, depression, anxiety, sleep problems, painful menstrual cramps, and numbness. Because FMS has no relevant organic pathology, it is placed in the realm of medically unexplained physical symptoms. Recent studies are providing early evidence for the use of eye movement desensitization and reprocessing (EMDR) therapy for chronic pain patients. Also, EMDR therapy is being used for other pain conditions, including fibromyalgia. Therefore, the EMDR Fibromyalgia Syndrome Protocol created includes the three-pronged protocol and an in-depth history of the client’s FMS and trauma. More research is needed to support this new protocol.

Migraine has been related to mental illness in the medical field for more than a century. The characteristics of migraine are head pain and neurological, gastrointestinal, and autonomic symptoms. A wide variety of treatments are available for migraine, including both medication and a variety of other therapies. Nonmedication treatments involve a lot of modalities such as behavioral therapy, diet modification, hypnotherapy, and biofeedback. Eye Movement Desensitization and Reprocessing (EMDR) therapy sees chronic pain, including migraine pain, as involving a disturbing somatic component, combined with the emotional reaction to the pain that gets stored in the brain. The EMDR therapy for pain integrates the processing of pain-related events accompanied by the disturbing emotional and body sensations related with the pain. EMDR therapy includes the three-pronged protocol and an in-depth history of the client’s migraine and trauma. More research is needed to support this new protocol.

The idea behind Eye Movement Desensitization and Reprocessing Therapy (EMDR) Protocol and Chronic Pain Control Protocol for the treatment of chronic pain conditions is to desensitize all of the emotional distress associated with the pain and after that to focus on the pain itself. The EMDR condition starts with a comprehensive assessment of the patient’s history to identify relevant traumatic and pain-related memories causing emotional distress and dysfunctional emotional response. It discusses the patient’s explanatory model, and subsequently provides psychoeducation to develop a better understanding of the links between trauma, pain, emotional response, and the principles of EMDR. Desensitizing and reprocessing starts by first targeting the most emotionally distressing memories; afterwards all pain-associated memories of subsequent events are focused until the subjective degree of distress of these memories drops down followed by current pain. Towards the end, future pain issues are targeted by the installation and reinforcement of EMDR-based skills.