Acquired immune deficiency syndrome (AIDS) has been with us for nearly twenty years, after being first recognized by the federal Centers for Disease Control and later labeled as the greatest public health threat in the United States. In the last two decades we have undergone a period of profound adjustment to the hard reality of AIDS.

The early response to the pandemic was too often the abject neglect and abuse of the historic casualties—gay men, intravenous drug users, men and women of color, and recipients of blood products. Extremist solutions of tattooing buttocks, calls for quarantine, unauthorized disclosures of...

These are difficult times for alcohol-and other drug-involved individuals, as well as for social workers who are committed to helping them. Despite recent declines in drug use (Substance Abuse and Mental Health Services Administration[SAMHSA] 1997), persons who suffer from addictive disorders continue to outnumber those experiencing most other types of major mental disorder in the United States. Two recent epidemiological surveys reported that from 16 percent to over 25 percent of the U.S. adult population has met the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for a substance use disorder at some time in their lives; over...

People who meet criteria for borderline personality disorder (BPD) present for services in almost every type of social work practice setting. Typical presenting problems are suicide attempts and gesture, family violence, substance abuse, eating disorders, reckless spending, and other problems with self-control. Social workers act therapeutically with persons with BPD not only when they are designated “therapist” but also in the roles of case manager or advocate (Goldstein 1983; Heller and Northcut 1996; Johnson 1988, 1991).

Clients with BPD are widely recognized as being difficult and frustrating to work with because of characteristics such as intense hostile-dependent feelings toward the...

Social work with individuals coping with chronic illness and disabilities is characterized by wide variation and diversity at both individual and systems levels. Assessment and intervention problems are challenging, and social and institutional contexts are only slowly developing more relevant service systems. Indeed, the problems are so varied that skilled social workers quickly learn the value in using a structured problem-specific assessment and case formulation process and a broad range of intervention approaches and techniques to provide comprehensive, effective care. Even so, the experience of persons with chronic illness and disability includes a number of profoundly important similarities as they...

Depression is so common in our society that it is often referred to as the “common cold” of mental illness. Depression is difficult to comprehend, assess, and treat effectively. Because it is so common in our society, social workers encounter depression in their work with clients regardless of their field of practice. Consequently, social workers have to be able to recognize and assess depression.

The impact of depression on society is enormous. At any point in time, 11 million Americans suffer from depression, and the cost in absenteeism and lowered productivity is 24 billion dollars annually. Individuals with depression are...

Developmental disAbilities is an area that requires multi-and interdisciplinary involvement. Social work is an important and essential component because of the profession’s practice, advocacy, programming, and social policy involvement. Further, social work contribution emphasizes the family-centered approach characterized by the provision of services within the context of the whole family. In this chapter, the abilities of individuals with disAbilities is emphasized; that is, the term disAbilities is viewed from a strengths perspective.

Developmental disAbilities are conditions and disorders that affect any areas of cognitive, physical, communication, social, emotional, and adaptive development. The federal definition of developmental disAbilities requires that an...

Eating problems such as anorexia nervosa and obesity have long been of interest to social work clinicians. More recently, with the growth in the incidence of bulimia, mental health workers have been increasingly interested in this disorder as well. An eating disorder can present as a sole problem or as one of many difficulties. These eating problems are encountered by social workers in medical settings, psychiatric clinics, community centers, and in private practice. Social workers should have a comprehensive theoretical understanding of eating disorders and be able to devise appropriate plans for helping their clients. Plans may include combinations of...

When we refer to someone as learning disabled, what do we mean? Many people would answer that the term learning disabilities refers to children with some specific cognitive deficits. This is what much of the public believes about people with learning disabilities. This is also what some in our profession currently believe. Yet such perceptions are dated and too narrow. Work on the subject during the past few decades has generated a wealth of new information, documented by research that has led to a significantly expanded perspective and to changing interpretations of the term learning disabilities.

A review of the...

Schizophrenia is a disease of the brain that affects approximately 1 percent of the population worldwide, regardless of race or gender. A combination of symptoms alters a person’s sense of reality and changes the ability to attend to normal life functions, such as work, school, and relationships. At its worst schizophrenia can impair an individual’s ability to take care of and monitor the simplest of the activities of daily living. A chronic and multifaceted illness, it affects every aspect of an individual’s life, distorting a person’s sense of self and altering how he or she experiences the environment. Those affected...

Even though the U.S. teen pregnancy rate is lower now than during the “baby boom,” public focus on the costs and consequences of adolescent sexual behavior has intensified over the past four decades. American teenagers still have higher pregnancy, birth, abortion, and sexually transmitted disease (STD) rates than teens in other industrialized countries. Each year, nearly one million American teenagers become pregnant (nearly 85 percent unintentionally), more than half a million bear children, and three million acquire an STD.

Dramatic transformations in family and labor market structures over the past forty years have left young Americans increasingly vulnerable to the...

In his famous work On the Genealogy of Morals, Nietzsche (1887/1989) wrote: “It is nowadays impossible to say definitely the precise reason for punishment” (8). More than a hundred years later, we are no more certain about the reasons society chooses to punish certain individuals. Originally a ritual for the redemption of sin through punishment, the rhetoric of imprisonment often takes on a decidedly theological cast (Sullivan 1990). As an integral part of the American criminal justice system, the prison provides a socially acceptable way to rationalize revenge through retribution.

Liberal ideologies about imprisonment and corrections, more likely to be...

A society’s investment in its future can be measured by its investment in its children. Despite the rhetoric concerning the centrality of children to families in the United States, the past thirty years have revealed a growing problem of abuse and neglect of children in the United States. Since Charles Kempe’s pioneering work identifying the “battered child syndrome” Americans have witnessed an explosion of knowledge about the causes and consequences of child abuse and neglect (Kempe et al. 1962). Unfortunately, the rates of documented harm or danger to children as a result of abuse or neglect has dramatically increased during...

From the earliest days of civilization, every society has had to develop some means of dealing with young children whose parents are unable or unwilling to provide adequate care. At various times in recorded history, children have been sold into slavery, donated to monasteries and convents under a process known as oblation, or left to die of exposure. Abandonment in public places was common from the days of imperial Rome until the end of the Middle Ages, when foundling hospitals were established in most European cities. Although this development marked a shift from reliance on the “kindness of strangers” to...

The victims’ movement has grown remarkably during the past three decades. In the mid-1970s victim rights advocates and victim service and victim/witness assistance programs were rarely available in cities and counties throughout the United States. As of 1999 there were more than nine thousand victim service and witness assistance programs, battered women’s shelters, rape crisis programs, and support groups for survivors of violent crimes nationwide. The proliferation of programs is a direct result of the 1984 Federal Victims of Crime Act (VOCA) funding, the 1994 Federal Violence Against Women Act, state and county general revenue grants during the 1980s and...

In the United States, clinicians, social workers, and other professionals have noted our society’s view toward death as typically one of denial; that is, we have tried not to think about it. People would “pass away” without little notice after a grave illness. However, the battle against HIV infection and AIDS has altered this denial, drawing death to the front-page headlines. The role of social work is vital in assisting bereaved families to cope with the death of a loved one. Because of the profession’s holistic perspective and scope of responsibility, social workers are in a unique position to understand...

The Book of Ecclesiastes proclaims that “to everything there is a season . . . a time to be born, and a time to die” (Eccl. 3:1). However, family members may not experience the death of a parent with this attitude of quiet acceptance, but instead complain that the death occurred “too soon” (out of season). Admittedly, a death of a person in young adulthood or midlife is untimely, and the death of a parent is always difficult.

Because of the implicit role of parents as nurturers and caretakers, their loss stirs up distressing feelings of anxiety based on the...

Each of these dilemmas results from divorce, which currently occurs in approximately half of U.S. marriages (Doherty, Kouneski, and Erikson 1998). Every year, numerous divorcing and divorced families are assisted by social workers in fields of practice such as family service, child welfare, school social work, and mental health. This chapter provides information and ideas for these social workers.

To help the diverse population of maritally disrupted parents and their offspring, social workers need awareness of divorce as a multifaceted process that unfolds over time, and a broad, contextual knowledge about divorce. They also need an eclectic practice orientation that...

Families clustered in small towns and scattered across the countryside of rural America are frequently characterized as “The People Left Behind.” Responding to a National Advisory Commission on Rural Poverty report, the Congressional Rural Caucus, in the early 1970s, focused national attention on this long neglected segment of the country (Martinez-Brawley 1981). The heightened visibility brought renewed recognition of the insufficient numbers, inferior quality, and often cultural incompatibility of social services provided in rural areas. A concomitant resurgence of interest in rural America took place within the social work profession. The Rural Social Work Caucus, formed in the early 1970s,...

Family care to frail elders represents a normative behavior that most American families strive to fulfill. Family members provide approximately 60 percent to 80 percent of long-term care for dependent elderly members (Bengtson, Rosenthal, and Burton 1996). Factors that motivate family caregivers to both assume and endure this tremendous responsibility include (a) altruistic motives such as love, affection, empathy, and feeling close; (b) self-serving motives that range from guilt over not doing more to a sense of personal satisfaction; (c) a sense of “mattering,” which refers to caregivers’ beliefs that they are valued by others because of the difference they...

The gay and lesbian population in the United States is largely an invisible one that makes itself visible in varying degrees depending on the prevailing societal climate. Because the lesbian and gay identity is not marked by identifiable physical characteristics, gay and lesbian persons can be easily overlooked as a vulnerable and yet highly resilient population group. This chapter explores the current and historic sociocultural definitions of same-sex relationships, demographic estimates about the population, and the societal context in which gay men and lesbians function. Further, the chapter analyzes vulnerabilities and risk factors associated with the population and explores the...

Widespread homelessness exploded on the American landscape in the late 1970s and 1980s. It was a social dislocation to an extreme that the country had not witnessed since the Great Depression. While initially choosing to deny the existence of homelessness, the press and the public eventually responded to this phenomenon with outrage and shock. Advocates and elected officials bitterly debated the extent and causes of homelessness. As the conservative eighties faded into the moderate nineties, homelessness became a fixed feature in our environment. We are still disturbed by the sight of homeless people who force us to confront the visible...

Immigrants comprise a sizable segment of the U.S. population. They are seen in service settings, such as health and mental health organizations, schools, community agencies, and in the workplace. Although the social work literature pays considerable attention to the ethnic diversity of immigrants, there is limited discussion of their experiences of migration. These include the cumulative stresses of leaving family, friends, community, and homeland and arriving in a new country, where immigrants need to find housing, learn a new language, secure education for their children, and find employment. Discussions of the policies that affect immigrants and the services available to...

Although violence toward intimates has undoubtedly existed for centuries, it was not until recently that violence and abuse in the context of adult intimate relationships was considered a social problem. Since being placed on the social problem agenda in the 1970s much has been learned about the nature of violence and abuse directed toward intimates as well as associated risk factors and consequences of such abuse. Although the etiology and risk factors for domestic violence have been a concern from the beginning, discussions of intimate partner abuse have rarely included a consideration of protective factors that may buffer those at...

Writing this chapter at the turn of the twenty-first century is both an extraordinary and disturbing experience. Without question, the lives of older persons reveal significant gains and accomplishments, and this pattern is expected to continue. Overall, longevity is increasing, physical health is improving, chronic illness is declining, and for many, financial status is improving. Healthier and longer lives provide additional opportunities for the creation of life’s pleasure. At the same time, a large portion of our older population, particularly women, ethnic minorities, and the oldest-old, live lives of unnecessary hardship, hardship created and secured by our capitalist economy. Without...

Substantial increases in the rates of divorce and nonmarital births have led to fewer children living with two parents. Some estimate that nearly one-half of all children will live in a one-parent family before reaching age 18 (Castro and Bumpass 1989). These changes in family structure have focused attention on the role of single parenthood in the well-being of children.

My classification scheme is based on two criteria: (1) whether a child is living with two parents (either biological parents or a biological parent and a stepparent) and (2) whether a child is living with only one biological parent without...

Suicide is the intentional taking of one’s own life. What pain is so intense, what circumstance so desperate, that it leads an individual to consider suicide? Suicide has provoked political, religious, and social debate since the time of the Greek philosophers. Understanding its cause and general prevention remain a source of study, speculation, and sleepless nights among those who make it their work and among those who live with its consequences. Few practitioners specialize in working with suicidal clients; however, many practitioners are called on to respond to a suicidal crisis in their work. The need to respond to this...

Trainers working on organizational racism and sexism issues often use an exercise entitled “What do you know about . . . ?” The workshop or seminar participants are asked to brainstorm all the ideas used to describe or understand a particular group of people. Trainers capture these ideas on newsprint and provide opportunities for the participants to review them periodically during the training session. The goal of the exercise is to elicit common cultural stereotypes about a particular group so that they can be replaced with more accurate information. Often, when the focus of this exercise is on communities of...

Think about the word work, and an endless stream of descriptors crosses one’s mind. Included might be financial support, social contacts, a means of organizing one’s day, a source of status, a sense of accomplishment, or alternatively demanding, dirty, dull, unhealthy, unsafe, stressful and lacking in fulfillment to list just a few. As a society we are ambivalent about work. Work is seen as a panacea that can remedy problems and a plague that precipitates them, as a cause of pernicious stress and a source of self-actualization. Yet work or the search for it is an activity that commands the...