Social work, as a professional and academic field, has long focused on work with children and young people and has been slow to grasp the opportunities and challenges of an ageing population (Ray et al. Reference Ray, Milne, Beech, Phillips, Richards, Sullivan, Tanner and Lloyd2014). The task of developing gerontological social work to meet the needs of an increasingly diverse population of older people has been addressed more vigorously in the United States of America (USA), through a range of initiatives designed to expand gerontological social work education, research and practice. The author of this book was a project Director for a Gero Innovations Grant for the Master's Advanced Curriculum Project funded by the John A. Hartford Foundation and Council on Social Work Education. The content reflects his involvement in curriculum design and teaching and private practice.
The author aims to provide social work students with a treatment focus that integrates theory, technique, concrete services, advocacy and social policy to avoid focusing narrowly on clinical micro practice. The book has two parts. The first gives an overview of theories, assessment techniques, treatment approaches and the impact of stigma on older adults, the second considers specialised problems and orientations in practice. The parts are divided into chapters, each ending with an illustrative case study and discussion topics.
Part One illustrates the kind of difficulties that need to be overcome in providing sound theoretical underpinnings for gerontological practice. Here, the author's starting point for developing a theoretical framework is a theory circle model which distinguishes between theories that inform practitioners’ understanding of older adults and theories that guide the choice of intervention. This distinction has an appealing simplicity but proves hard to apply with rigour and consistency. The first chapter introduces a few theories to aid social workers’ understanding of older adults: the idea of chronological age stages, as used by researchers; Erikson's stages of psychological development; and the concept of resilience and person in environment theory. The last is intended as a counterweight to the traditional medical model and its inherent pathologising of the older person. Surprisingly, current well-established psycho- and socio-gerontological understandings of the process and experience of ageing are absent from this chapter. There is, for example, no mention of adaptive development, the third and fourth age, the lifecourse perspective or the political economy of ageing. In the third and fourth chapters, on intervention theories and stigma, respectively, a wider range of theoretical perspectives emerges including, for example, a discussion of ageism, empowerment theory, narrative theory and cognitive behavioural theory, but the distinction between theory for understanding or for intervention becomes increasingly blurred. It was puzzling to discover the political economy of ageing briefly surfacing in Chapter Three, under the heading existential-phenomenological theory. Chapter Two on assessment is perhaps the most useful in this part. It gives detailed attention to setting and process and helpful pointers for observation and inquiry across a wide range of assessment activities. Some domains given only brief consideration here are treated in greater depth later, but it was startling to note that assessment of a person's spiritual/religious perspective gets only a passing mention whilst there is detailed attention to assessment of homicide risk. The reader is advised that ‘a homicidal assessment is required whether a social worker suspects homicidality or not’ (p. 32).
The chapters in Part Two cover key topics such as dementia, care settings, and death and dying in old age, and others, such as substance abuse, sexuality in late life and lesbian/gay/bisexual/transgender older adults, that are only slowly emerging, if at all, in the social work curriculum. There is much useful material in these chapters for students and practitioners, particularly about the range of possible interventions and the evidence for or against their use. However, some readers may question the prescriptive tone and find the writing style a barrier – as the transition from lecture notes to text often appears incomplete.
A potential difficulty for readers outside the USA is that there is no explanation of the policy and practice context for the gerontological practice described here. Given the breadth of coverage in other respects and the focus on clinical social work within the USA, this is perhaps unfair. Nevertheless, readers from elsewhere who are worried about the marginal state of gerontological social work in their countries and seeking useful ideas for policy and practice transfer are unlikely to find much here to inform their thinking. However, there is certainly material here to support the case for the role of gerontological social work and its effective contribution to meeting the needs of the growing numbers of people negotiating the challenges of late life.
