Contingent hope theory: The developmental exploration of hope and identity reconciliation among young adults with advanced cancers.

OBJECTIVE: The diagnosis of an advanced cancer in young adulthood can bring one's life to an abrupt halt, calling attention to the present moment and creating anguish about an uncertain future. There is seldom time or physical stamina to focus on forward-thinking, social roles, relationships, or dreams. As a result, young adults (YAs) with advanced cancer frequently encounter existential distress, despair, and question the purpose of their life. We sought to investigate the meaning and function of hope throughout YAs' disease trajectory; to discern the psychosocial processes YAs employ to engage hope; and to develop a substantive theory of hope of YAs diagnosed with advanced cancer. METHOD: Thirteen YAs (ages 23-38) diagnosed with a stage III or IV cancer were recruited throughout the eastern and southeastern United States. Participants completed one semi-structured interview in-person, by phone, or Skype, that incorporated an original timeline instrument assessing fluctuations in hope and an online socio-demographic survey. Glaser's grounded theory methodology informed constant comparative methods of data collection, analysis, and interpretation. RESULTS: Findings from this study informed the development of the novel contingent hope theoretical framework, which describes the pattern of psychosocial behaviors YAs with advanced cancer employ to reconcile identities and strive for a life of meaning. The ability to cultivate the necessary agency and pathways to reconcile identities became contingent on the YAs' participation in each of the psychosocial processes of the contingent hope theoretical framework: navigating uncertainty, feeling broken, disorienting grief, finding bearings, and identity reconciliation. SIGNIFICANCE OF RESULTS: Study findings portray the influential role of hope in motivating YAs with advanced cancer through disorienting grief toward an integrated sense of self that marries cherished aspects of multiple identities. The contingent hope theoretical framework details psychosocial behaviors to inform assessments and interventions fostering hope and identity reconciliation.

Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.

This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.

Online training on fetal alcohol spectrum disorders for court-appointed special advocates volunteers.

Fetal alcohol spectrum disorders (FASDs) are a leading cause of developmental disabilities. Children within the child welfare system are five to 10 times more likely than other children to experience these symptoms. Court Appointed Special Advocates (CASA) volunteers are uniquely positioned to identify these children and refer them for assessment and services. This study used a one-group pretest-posttest design to assess the impact of a three-hour online FASDs training on CASA workers' knowledge of FASDs and their comfort and confidence in identifying children with FASDs for referral, advocating for them, and linking them to services. The training and assessment measures were completed by 338 CASA volunteers and staff from 55 CASA locations in Texas. Wilcoxon matched-pairs tests and paired t tests were used to assess change in each of the dependent measures. All comfort and confidence items showed significant improvement from pretest to posttest; there was also a significant improvement in knowledge. These results support the potential of this online training to enhance CASA volunteers' ability to help children with FASDs.

Disoriented grief: a lens through which to view the experience of Katrina evacuees.

Many studies on the impact of natural disasters have focused primarily on immediate stress reactions and posttraumatic stress disorder (PTSD) symptoms rather than on evacuees' stories of grief and loss. Known categories of grief and loss do not fully capture the experiences of disaster survivors as evidenced by interviews of Hurricane Katrina evacuees in Austin, Texas. This article will describe their experiences through a resultant framework of Disoriented Grief.

HIV testing rates and testing locations, by race and ethnicity.

The purpose of this study is to report the HIV testing rates among white Americans, African Americans, and Hispanic Americans and to identify the frequency of use of HIV testing locations according to a variety of sociodemographic variables. Data for this study came from the 2005 Behavioral Risk Factor Surveillance System (BRFSS). Participants in the BRFSS were recruited from residential households in the United States through an ongoing, random-digit-dial telephone survey. Results showed that 40 percent of all participants had been tested for HIV and that HIV testing rates significantly differed by racial-ethnic group. Gender and income were not significant factors for HIV testing rates among African Americans. Marital status was not a significant factor for Hispanics. Overall, 41 percent of the sample had been tested at a private doctor's office or HMO facility, and 24 percent had been tested at a clinic. Hispanics were the only group more likely to have been tested at a clinic. Recommendations for increasing rates of testing among all racial-ethnic groups based on testing locations are explored. Implications of the findings that certain racial-ethnic groups are reporting higher rates of HIV testing and higher rates of new HIV infections are discussed.

Domestic violence shelters as prevention agents for HIV/AIDS?

The article reports findings from a pilot study of 21 domestic violence shelters in a southwestern state in the United States. The survey instrument included descriptive information on shelter service delivery. Specifically, questions were asked about the practice of assessing a client's risk of HIV/AIDS, the provision of HIV/AIDS educational and prevention programs within shelters, and information about organizational characteristics that facilitate or impede the existence of these services. The findings suggest that shelters lacked sufficient HIV/AIDS policies and programs to respond to their client's heightened risk of infection. Although 19 (90.5 percent) of the shelters reported that they routinely ask about their clients' sexual abuse histories, there was no link between a woman's disclosure of sexual abuse and a subsequent provision of appropriate HIV/AIDS services (referrals for testing, treatment) by the shelter. HIV/AIDS awareness was high among the shelter staffwho responded to the survey, but HIV/AIDS prevention and education were practically nonexistent. Implications for social work practice are discussed.