Overview of Field Placement Agency—Catholic Charities

Overview of the Field Placement Agency

Catholic Charities, centrally located close to downtown Raleigh, North Carolina, serves clients living within and below poverty economic status. Founded over a century ago by Benedictine monks and the Sisters of Mercy (Catholic Charities, 2014), the organization provides individual, couple, and family counseling services and is known for its dedication to serving diverse cultural and economic clients. Catholic Charities’ mission is to

perform corporal works of mercy to include feeding the hungry, sheltering the homeless, clothing the naked, giving alms to the poor, provide direct services to individuals and families by collaborating with a range of community partners to ensure vulnerable and isolated families in our communities are cared for (Catholic Charities, 2014).

Services provided by Catholic Charities include adult counseling, school counseling, adoption services, food pantry, case management services, and emergency assistance. Catholic Charities offers services on a sliding scale fee to clients who are uninsured or under-insured. Services are offered in both English and Spanish to accommodate a more diverse range of clients.

Agency Staff Profile

Catholic Charities of Raleigh is run by a small multi-disciplinary team. The agency is overseen by a Regional Director. Case management and community referral services are performed by two Case Managers. Counseling services are provided by three Social Workers who are Licensed Certified Social Workers (LCSW) and two Masters of Social Work (MSW) interns. The MSW interns are supervised by the LCSW counselors in order to ensure clinical appropriateness, assist with treatment planning and diagnosis, and adhere to accreditation regulations. There is one Adoptions Coordinator overseeing and assisting with adoption services, and an Office Manager tends to all administrative duties including insurance billing, scheduling appointments, and answering the phone.

Program Background and Activities

The adult counseling program at Catholic Charities is the focus of the problem identification and needs assessment. The program serves adults in need of counseling services, and this assessment focuses on elderly clients. The counseling program seeks to help clients work through emotional distress; develop coping tools for stress, depression, and anxiety; heal from grief and loss; gain skills for relationships and life struggles; and grow towards their full potential. Counselors strive to provide holistic treatment through recognizing issues, improve functioning, and facilitating healing and growth in emotional, behavioral, spiritual, cognitive, and physical aspects of clients’ lives. With the elderly clientele, one of the major problems being faced in counseling is depression. In general, elderly people are at greater risk for depression due to the tendency to isolate from social circles and peer groups (Mills, 2011). Counseling services as well as community networking are crucial to treatment of these clients. Length of treatment varies depending on a number of factors including history of mental health issues or mood disorders, availability of social or community connections, and client willingness.

Counselors work with clients using different techniques depending on the situation. Treatment can range from a few sessions of brief therapy to a much longer psychotherapeutic span of treatment. Both individual and couples counseling are offered, and the treatment modalities utilized include cognitive-behavioral therapy (CBT), Solution Focused Therapy, Motivational Interviewing, and Problem Solving Therapy. Each client is assigned to one of the LCSW counselors or MSW interns. The interns are closely supervised by licensed clinicians. Because Catholic Charities does not provide psychiatric services, clients are encouraged to see a psychiatrist if medications are necessary for treatment.

As Catholic Charities serves clients within and below poverty status, many of the clients seeking mental health services are uninsured. For uninsured clients, Catholic Charities offers a sliding scale fee based on income and family size (Catholic Charities, 2014).

Stakeholders

Stakeholders of Catholic Charities include clients, client families, employees, volunteers, consultants, the Board of Trustees, consumer advocates, donors and funding parties, contractors, and partners. These individuals and agencies have a vested interest in improving the quality of life for the underprivileged population of Raleigh. Clientele and families are directly affected by the success of the counseling program and its ability to offer low-cost counseling and community services. The employees and volunteers work together to provide assistance and services for the clientele as well as community awareness of Catholic Charities and the services available. Corporate stakeholders include the Bishop’s Annual Appeal, providing approximately 30% of the programs funding (Catholic Charities, 2014), the Catholic Diocese of Raleigh, and financial donors and supporters. With the assistance of its stakeholders, Catholic Charities can continue to provide quality counseling and social services to those who are in poverty status.

Problem Identification

Counselors at Catholic Charities have noticed the prevalence of depression in elderly clientele and that depression tends to be associated with loneliness and isolation in these clients. The Diagnostic and Statistical Manual of Mental Disorders describes depression as displaying symptoms of depressed mood or irritability for a period of at least two weeks at least five of the following: loss of interest in daily activities; change in appetite or weight; change in sleep; change in daily activity; loss of energy; feelings of guilt and worthlessness; difficulty concentrating; and suicidal thoughts and/or plans (American Psychiatric Association, 2013). Areas of impairment may include stress in marital or family relationships, poor performance at work if still in the work force, decreased socializing, lessened ability to care for self, and self-injury. Specifically, counselors at Catholic Charities noticed a correlation between social isolation, self-reported loneliness, and symptoms of depression.

Significant research has been performed on depression in elderly populations. Djernes (2006) found that while up to 9.4% of adults report symptoms of depression, up to 16% of elderly persons living alone or in institutions report experiencing depressive symptoms. Loneliness has significant associations with depression and may cause depression (Luanaigh & Lawlor, 2008). Elderly women seem to be at higher risk than elderly men for loneliness, which is commonly associated with depression, with 25% of men reporting feeling lonely and 40% of women reporting feeling lonely (Golden et al., 2009). Possible causes for loneliness and social isolation include a lack of organizations and groups in elderly communities, lack of transportation resources, and physical or mobility limitations. Additionally, the elderly often have less income to engage in activities which can also encourage isolation. Imran et al. (2009) associate satisfaction with personal income with a lower risk of depression in the elderly. After retirement, many people find that retirement savings and social security do not afford enough to cover social activities in addition to the cost of living and medical expenses.

Djernes (2006) found that somatic illness, cognitive impairment, and the loss of former social contacts can contribute to isolation and loneliness in the elderly. As people become less able to interact with loved ones, their sense of isolation and loneliness increases and can develop into depression if not properly addressed. Additionally, van Veer-Tazelaar et al. (2008) found that depressive symptoms increase with age. They attribute this change to age-related changes in risk factors rather than ageing itself. As people age, they commonly become more fearful of potential health and safety risks such as falling, having a medical emergency while away from home, decreased hearing and eyesight, and the potential for memory loss. Chronic illness is a multi-dimensional problem with a variety of components to manage. The chronically ill must remain vigilant of treatment regimens, symptoms, crisis prevention or management, medications, illness trajectory, and dealing with medical professionals (Biordi & Nicholson, 2012). Because of the immediacy of the physical components of chronic illness, maintaining self-image, emotional stability, and social connections often become less important. It is not uncommon for elderly people with illnesses to remain at home rather than go out into the community to engage with peers, friends, and family.

Functionality also links strongly to depression. An and Tak (2009) correlate lessened ability to engage in activities of daily living (ADT) as a predecessor to elderly depression. As people lose the ability to engage in daily activities such as driving, shopping, preparing food, and personal hygiene, they begin to require assistance from family or professionals. Many people experience a loss of dignity at no longer being able to take care of themselves, and they can potentially experience a sense of worthlessness and hopelessness associated with this loss.

In addition to causing depression, adverse health conditions can also be worsened by depression and loneliness. According to a study by Luanaigh and Lawlor (2008), loneliness appears to negatively impact both physical and mental health including blood pressure, sleep, immune stress responses, and cognitive capacities. They explain that another detriment is that there are few evidence-based treatments for loneliness.

It is important to provide counseling services to elderly people with depression. In addition to depression contributing negatively to physical health in older people, untreated depression has the potential to lead these sufferers to attempt suicide. Gibbs et al. (2009) associate depression with suicide attempts in elderly populations. The surveyed individuals over the age of 60 and found that those who were suicidal were also not only depressed, but lacked problem solving abilities. Counseling can provide elderly clients with problem solving strategies and coping tools to help mitigate this risk. Additional potential methods of help elderly clients with isolation and the subsequent depression include encouraging healthy social contacts, teaching and practicing social skills, therapeutic techniques designed to improve self-esteem, developing a support network, and providing community resources.

Needs Assessment Plan

The purpose of the needs assessment of Catholic Charities of Raleigh is to evaluate how effective the program is in treating elderly clients with depression and isolation as their presenting problem. The needs assessment will also identify gaps and areas of improvement in order to provide solutions for improving the quality of care for elderly clients. The information from the needs assessment will be presented to Catholic Charities’ Regional Director and LCSWs in order to develop appropriate solutions for areas of lack in the current method of treating depression and isolation in elderly clients.

Research shows that one of the most effective ways to treat depression in elderly clients is to form social networks through support groups, mutual aid, and the re-building of family networks (Biordi & Nicholson, 2012). Catholic Charities offers individual and couples therapy to adults, and clinicians are free to choose the most appropriate theoretical framework for working with clients. However, group support for elderly clients is not available at Catholic Charities. Because of this, it is important to maintain an updated and comprehensive knowledge of community resources and support groups. Clients who meet the criteria can be given recommendations to social functions, community organizations, and support groups in order to increase socialization and hopefully decrease depressive symptoms.

In order to assess loneliness and depression, a number of assessments and tools will be used during interviews including surveys and Likert scales. Fine and Spencer (2009) suggest that the scales used to assess loneliness, isolation, and depression be shorter rather than longer due to the possibility of response resistance. In lieu of shorter surveys, extracts or portions from longer surveys can be used. The surveys proposed to assess depression and loneliness in Catholic Charities’ elderly clients are the Loneliness Scale, Satisfaction with Life Scale, and the Quality of Life interview (see Appendix A) (Fine & Spencer, 2009). Counselors will receive the scales and will be asked to conduct the assessments with clients aged 65 and older. Names and specific ages will not be recorded in order to protect the confidentiality of the clients. However, gender will be recorded in order to assess gender differences in the treatment of depression and isolation.

Data analysis will be taken from the three assessment tools and will be presented to clinicians for review and valuation. Subsequently, data will be presented to the Regional Director along with the case workers, LCSWs, adoption counselor, and interns in order to explain the statement of need.

Needs Assessment Summary

The literature review conducted on elderly clients and depression and isolation presents a clear need for treatments geared towards developing social connections in order to diminish depressive symptoms and receive peer support. When the interviews and surveys from this needs assessment are performed, it is assumed that the findings will present a need for more group-oriented treatments for elderly clients. One possible solution for this is to compile a comprehensive list of community referrals for the elderly population. This will include the case workers and will focus on organizations and groups that target social interaction among the elderly. This might include activity groups, social outings, peer support groups, or group therapy for depression. Additionally, family members can be solicited to assist in transportation, assistance with any medical conditions, and participation in social activities and functions.

Catholic Charities may also want to consider implementing in-house group counseling for elderly clients. For those who meet pre-determined criteria for depression and isolation, groups can be recommended. An open group for practicing socialization, communication skills, and solutions for issues of aging can be held weekly and inclusive to any who meet the criteria to join. Additionally, Catholic Charities may want to consider creating a series of closed therapy groups for clients with a pattern of Major Depressive Disorder focusing on generating and practicing solutions for life issues related to depression and anxiety. Providing in-house counseling and therapy groups rather than community referrals for the groups would serve two purposes. One, clients may be more willing to attend groups at a clinic with which they are already familiar rather than a new facility. Two, clinicians will be able to obtain a fuller understanding of client needs with a multi-faceted treatment than with individual sessions.

Conclusion

With the prevalence of depression and isolation in older clients, particularly the female elderly, it is important for Catholic Charities of Raleigh to provide services to meet the needs of this population. This needs assessment assists in generating greater awareness in clinicians of the problems facing the elderly and the best practices for ensuring the most effective treatment for these clients. By exploring the need to offer support groups and group counseling, Catholic Charities has the potential to offer existing and future elderly clients a fuller and more effective treatment program.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.

An, J. Y., & Tak, Y. R. (2009). Depressive symptoms and related risk factors in old and oldest-old elderly people with arthritis. Journal of Korean Academy of Nursing, 39(1), 72-83.

Biordi, D. L., & Nicholson, N. R. (2012). Social isolation. Chronic Illness 8e, 85-115.

Catholic Charities. (2014). Home. Retrieved from http://www.catholiccharitiesraleigh.org/

Djernes, J. K. (2006). Prevalence and predictors of depression in populations of elderly: A review. Acta Psychiatrica Scandinavica, 113(5), 372-387.

Fine, M., & Spencer, R. (2009). Social isolation development of an assessment tool for HACC services. Center for Research on Social Isolation, Macquarie University.

Gibbs, L. M., Dombrovski, A. Y., Morse, J., Siegle, G. J., Houck, P. R., & Szanto, K. (2009). When the solution is part of the problem: problem solving in elderly suicide attempters. International Journal of Geriatric Psychiatry, 24(12), 1396-1404.

Golden, J., Conroy, R. M., Bruce, I., Denihan, A., Greene, E., Kirby, M., & Lawlor, B. A. (2009). Loneliness, social support networks, mood and wellbeing in community‐dwelling elderly. International Journal of Geriatric Psychiatry, 24(7), 694-700.

Imran, A., Azidah, A. K., Asrenee, A. R., & Rosediani, M. (2009). Prevalence of depression and its associated factors among elderly patients in outpatient clinic of Universiti Sains Malaysia Hospital. The Medical Journal of Malaysia, 64(2), 134-139.

Luanaigh, C. Ó., & Lawlor, B. A. (2008). Loneliness and the health of older people. International Journal of Geriatric Psychiatry, 23(12), 1213-1221.

Mills, T. L. (2011). Comorbid depressive symptomatology: Isolating the effects of chronic medical conditions on self-reported depressive symptoms among community-dwelling older adults. Social Science & Medicine, 53(5), 569-578.

van Veer-Tazelaar, P. J. N., van Marwijk, H. W., Jansen, A. P., Rijmen, F., Kostense, P. J., van Oppen, P., & Beekman, A. T. (2008). Depression in old age (75+), the PIKO study. Journal of Affective Disorders, 106(3), 295-299.

(Appendix A omitted for preview. Available via download)