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Archive for the ‘
Family Genetics ’ Category
Norma Turner, 14, is her mother's daughter. Her mother, Kareen Brown, held a recent portrait of the two of them, which showed their striking resemblance. The same eyes, same face, same tendrils of hair, the same happiness shines out of the picture.
They also suffer from a disorder that puts them both at high risk for developing cancer and subjects them to numerous preventive operations. "It's in the family, the genes," Ms. Brown, 35, said.
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Genetic testing is a type of medical test that is used to detect changes or abnormalities in chromosomes or genes related to inherited diseases. More than 900 genetic tests are now available through diagnostic laboratories. The tests have the potential to offer valuable health information, but they can also introduce ethical dilemmas.
- Confirm a suspected diagnosis of disease.
- Predict a susceptibility to inherited diseases long before symptoms appear; currently used primarily with individuals who have a strong family history of the disease such as breast, ovarian cancer, or Huntington’s Chorea.
- Determine the carrier status for cystic fibrosis, Tay-Sachs, and other inherited diseases that adults may pass on to their children.
- Predict responses to medication therapy.
- Determine if a fetus is at an increased risk of genetic disorders or physical deformities.
- Improved diagnosis of diseases and earlier detection.
- More accurate prognosis of diseases that are likely to spread quickly.
- Customized medications for a person's specific genetic profile.
- Tests portray a risk or probability of contracting a particular disease.
- Tests may not detect every disease-causing gene mutation in a person's DNA.
- A negative result does not mean that the disease will not develop at some point in the future.
- Genes are only one factor in disease development. In some disease, environmental factors can also be contributing factor.
- A false positive test will result in unnecessary worry and concern about health issues.
- Tests provide information about relatives in addition to the person testing and therefore, test results may provide knowledge about potential diseases that other family members would prefer not to know.
- People have been denied health insurance, lost jobs, and even been turned down for adoption due to the results of genetic tests. The consequences of disclosure are complex and should be considered carefully.
- Testing can be expensive and may not be covered under health insurance policies.
- Assist an individual or family to decide whether to proceed with genetic testing.
- Confirm, diagnose, or rule out a genetic disorder.
- Identify issues related to health management.
- Discuss genetic risks.
- Support family members and provide referrals to support groups and local service agencies.
Sources:
- Access Excellence Resource Center
- Mayo Clinic
- National Cancer Institute
- National Institutes of Health
- Nemours Foundation
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Introduction
Our genes determine our physical appearance, our personality, how our body functions, and other characteristics that make each person unique. Each of us inherits from our parents as many as 35,000 different genes.
As genes are passed down from generation to generation, medical conditions and diseases, or the increased risk for disease, tend to run in families due to gene abnormalities. Health care professionals now better understand how irregular genes are passed from one generation to the next and have an increased ability to test for hundreds of inherited illnesses.
Through DNA samples of small quantities of blood, skin, hair, or other tissues or fluids, scientists can identify defective genes that may indicate future health problems. A genetic defect in one specific gene, for example, can cause an inherited disorder such as cystic fibrosis, sickle cell anemia, or Tay-Sacs disease.
It is now known that abnormal inherited genes are also responsible for an increased risk for certain types of cancer, diabetes, Alzheimer's disease, Parkinson's and other common diseases that were not always linked to genetic factors.
Many mental illnesses may be the result of simultaneous changes in several different genes. An estimated 50 to 75 percent of depression is inherited, according to the Nemours Foundation, but the specific genes linked to depression have not yet been found.
Genetic testing is commonly used in unborn fetuses, newborns, and people who have a high risk of developing a particular disease due to a strong family history of the disorder. Some couples who are planning a pregnancy may decide to have a genetic test to determine their chance of passing on a genetic disorder to their children. Tests are also used to confirm a diagnosis so doctors can formulate an effective treatment plan.
Prenatal tests determine the risk for genetic disorders and physical deformities. Parents over age 35, parents with a family history of a genetic disorder, and pregnant women who have been exposed to harmful chemicals may consider prenatal testing.
Common prenatal tests include the triple screen of the mother's blood to test for Down syndrome, spina bifida, and other genetic disorders and an amniocentesis, a test of the amniotic fluid. The percutaneous umbilical blood sampling test can detect sickle cell anemia, hemophilia, and anemia.
Prenatal testing can provide information that is not available through regular prenatal health visits. Pregnant women will want to weigh the risks of testing, such as pain, worry, and the possibility of a miscarriage, with the value of knowing what the tests may find.
Blood samples from newborns are routinely tested in hospitals to identify rare metabolic disorders that could result in seizures, stunted growth, or life-threatening conditions. The types of tests required are mandated by state law.
More than 25 different medical conditions can be identified through sampling a few drops of blood taken from a baby's heal. Every state requires the testing of phenylketonuria (PKU) that, if left untreated, can result in mental retardation and seizures. When the condition is caught early, doctors can prescribe a diet that will prevent medical problems or minimize complications.
Early diagnosis of medical conditions is important in helping parents to understand the health issues that their newborn will face and to consider genetic testing to address the possibility that future children may be born with the same condition.
Women who are at higher risk of developing breast or ovarian cancer due to the incidence of cancer in one or more close relatives and other factors may consider genetic testing to identify abnormal genes that are linked to cancer risk.
Genetic testing can be useful in guiding health care; for example, women who have a particular gene mutation have a significantly higher risk of developing cancer: a 65 percent chance of developing breast cancer, compared with a 12 percent lifetime risk for most women, according to Mayo Clinic. This information will help a woman and her physician determine the appropriate prevention and early detection strategies.
Having a family history of breast or ovarian cancer does not necessarily indicate that the illness is hereditary or that the mutated gene has been passed on. Inherited breast cancer makes up only 5 to 10 percent of all breast cancers.
Women who test positive for genetic mutations can begin preventive strategies, such as exercising, losing excess weight, and taking a medication to reduce cancer risk. In addition, early detection measures are vital, such as regular mammograms and physical examinations.
Many people are not aware that men can also get breast cancer. Detailed family medical history and genetic information is also important for men to be aware of so they can receive appropriate screening and medical care.
Like all medical tests, genetic testing is not 100 percent accurate. Positive tests don't predict the exact probability of developing a disease or the severity of the disease if it develops. Genetic tests are continually being developed and improved, but they may not detect all of the complex mutations that could cause a disease. In this case, a false negative test could provide a false sense of security. Likewise, a false positive test could promote unnecessary worry and concern.
Individuals who are deciding to undergo genetic testing are encouraged to seek accurate information about all of the benefits and risks involved.
Genetic counseling services are available to help individuals and families with the decision-making process. If genetic testing is pursued, genetic counselors can help calculate the risks, decipher the test results, identify medical management issues, and provide various types of support. Physicians can refer patients to genetic counselors or to a genetic counseling center in the community.
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Introduction
A doctor may recommend genetic counseling or testing for any of the following reasons:
- A couple is planning to start a family and one of them or a close relative has an inherited illness. Some people are carriers of genetic illnesses, even though they don’t show, or manifest, the illness themselves. This happens because some genetic illnesses are recessive – meaning that they’re only expressed if a person inherits two of the problem gene, one from each parent. Someone who inherits one problem gene from one parent but a normal gene from the other parent won’t have symptoms of a recessive illness but will have a 50-50 chance of someday passing the problem gene on to their own children.
- An individual already has one child with a severe birth defect. Not all children who have birth defects have genetic problems. Sometimes, birth defects are caused by exposure to a toxin (poison), infection, or physical trauma before birth. Even if a child does have a genetic problem, there’s always a chance that it wasn’t inherited and that it happened because of some spontaneous error in the child’s cells, not the parents’ cells.
- A woman has had two or more miscarriages. Severe chromosome problems in the fetus can sometimes lead to a spontaneous miscarriage. Several miscarriages may point to a genetic problem.
- A woman has delivered a stillborn child with physical signs of a genetic illness. Many serious genetic illnesses cause specific physical abnormalities that give an affected child a very distinctive appearance.
- A woman is pregnant and over age 34. Chances of having a child with a chromosomal problem (such as trisomy) increase dramatically when a pregnant woman is older.
- A child has medical problems that might be genetic. When a child has medical problems involving more than one body system, genetic testing may be recommended to identify the cause and make a diagnosis.
- A child has medical problems that are recognized as a specific genetic syndrome. Genetic testing is performed to confirm the diagnosis. In some cases, it also may aid in identifying the specific type or severity of a genetic illness, which can help identify the most appropriate treatment.
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Introduction
Our genes or DNA determine what we will look like, how we will grow, what diseases we may have or inherit, and some of our reactions to the environment. Recent advances in biology, technology, and genetics have had a significant impact on the lives of many couples and families, because now we can anticipate which traits may be passed down from one generation to another, through the genes.
Genetic testing of prospective parents can identify those who carry a disease that may be passed on to their children. Genetic testing of fetuses provides information about potential birth defects, and gives couples high level probability information upon which to base decisions. These new technologies have given us sophisticated information and advanced technical solutions, but often without the accompanying practical, emotional, and ethical guidelines to handle the information and experiences.
New dilemmas are created as couples are called upon to make difficult life and death decisions, such as terminating a pregnancy, which can have far reaching practical, spiritual, and emotional consequences. When genetic defects lead to fetal loss, whether by miscarriage, elective termination, or stillbirth, it can be a devastating experience with ripple effects on couple and family development.
Pregnancy Loss
Miscarriage occurs frequently, occurring in 20 percent of all pregnancies and in one-third of all women, a loss which affects 2.5 million Americans, and more if one counts their families. Despite the frequency of its occurrence, fetal loss is an under acknowledged and under treated experience.
Society seems to downplay the event with social pressure to recover and "get over it," which may be a result of others’ discomfort with sadness and loss. Silence and awkward communication from friends, relatives, and co-workers often leave the couple feeling estranged and isolated. It is possible that the minimizing of the loss may actually prolong adjustment and recovery. It is not unusual when such a loss becomes submerged and reappears years later as "unfinished business" in the life of a couple.
In reality, each loss can evoke a full scale grieving process, with emotions such as denial, anxiety, anger, guilt, and depression. These losses are difficult in part because they are out of sync with life cycle expectations, and shatter dreams of a healthy baby or of a future as parents. There may be resurgence of old losses, or an exacerbation of pre-existing conditions, such as depression. While such losses may bring the couple together in mourning, they are just as likely to create crisis and distance, especially in relationships with pre-existing difficulty.
According to the National Institutes of Health (NIH) the average time it takes to recover emotionally from a miscarriage can range from nine to fifteen months. Emotional reactions will be influenced by one’s family, one’s gender, religious beliefs, and cultural rules about grieving.
Some partners express emotions and grieve differently, and often leave parents coping in different ways. One partner may not show outward displays of grief in an effort to protect the other from facing difficult feelings, but this may result in the other partner feeling more isolated and alone. The participation of extended family members, friends, co-workers, the nature of the hospital experience, doctor-patient relationship, and availability of supportive resources, will all affect how a couple deals with the situation.
The Mixed Blessing of Genetic Testing
Half of all miscarriages are due to the chromosomal abnormalities passed to the child by the parents. Testing of parental chromosomes is generally done after the third miscarriage.
Prenatal genetic testing is recommended when the mother is 35-years old or older. Becoming pregnant at a relatively older age is the most common cause of reproductive failure due to genetics.
The detection of Down’s syndrome is a common reason for genetic testing. Down’s syndrome is the most frequent genetic cause of mild to moderate mental retardation and associated medical problems. In women age 35, the rate that Down’s syndrome occurs in the general population is one in 400 pregnancies. However, by age 45 that incidence increases dramatically to one in 35 pregnancies.
Other reasons for genetic testing are a family history of genetic disease, two or more unexplained miscarriages or pregnancies with birth defects, and exposure to potentially harmful substances. There is some risk in the testing itself and some couples are ambivalent and even avoid testing. The testing can be stressful, depending on the results, disease found, degree of uncertainty, nature of the decision needing to be made, coping options available, and personal factors in the couple.
The vast majority of couples choose to terminate the pregnancy once severe abnormalities are detected. Having to make such weighty decisions, made worse by only probability scenarios, can burden couples who need to make crucial decisions without all the information that would make those decisions easier.
When termination is elected, many couples experience some level of depression, fear, anger, and guilt. Risk factors include prior history of depression, poor social support, ambivalence or pressure about the termination decision, and disturbed marital and family communication. Societal, familial, legal, and religious attitudes can affect the degree of stress.
For example, a very religious extended family may shame and disapprove of the couple’s decision to terminate. Diagnosis of abnormalities late in the pregnancy may result in a necessary termination via vaginal delivery of a dead baby, which is most difficult on a couple medically, emotionally, and ethically. Sometimes a couple feels traumatized by the medical procedures, and they may be unnerved by the unexpected depth of their emotional reactions.
Genetic counseling is generally recommended after three miscarriages to help the couple get more information about a possible undiagnosed genetic condition, and make decisions based on this information. Genetic counseling offers support in understanding options, clarifying decision-making, helping with coping, and recommending resources.
It cannot fully address the subsequent unfolding of the grieving process, which begins after the medical procedures are undergone, and continues for some time after. Furthermore, some couples are plagued with unanswered spiritual questions, and need time to adapt to their changed reality and future direction.
Since couples in this population have a high risk of recurrence of genetically affected pregnancies, stresses can be cumulative, as in the case of an infertility diagnosis. Infertility treatments involve extended arduous testing, and often years of expensive and intensive clinical interventions, with only mixed success rates. There is a growing awareness of the powerful impact that infertility has on the life of a couple and family.
Referral for social work follow up and continued counseling following pregnancy loss is indicated in situations of prolonged grieving and depression, ongoing difficulty in couple communication, and strained extended family relationships. This counseling can be important because how the loss is handled will impact sexual and emotional intimacy in the couple, future children, and interpersonal relating among family members. Couples often benefit from social work counseling to resolve their feelings about the loss, recover from the experience, begin to heal, return to daily life and work, and take new steps in their lives.
How Social Workers Help Couples Recover from Pregnancy Loss
Social workers are well equipped to intervene in complex problems of loss from a multidimensional perspective, incorporating biological, psychological, and social factors. Social workers can help "buffer" the effects of pregnancy loss by seeing the couple as a unit, searching for adaptive strengths, improving sharing and communication. These efforts can strengthen the couple’s ability to cope and be resilient for the future.
Specific ways in which social workers help are:
- Strengthening the couple as a unit by seeing them together and encouraging their setting time aside for talking and listening to one another
- Creating a safe, accepting, empathic environment
- Providing comfort to the individuals for each one’s unique experience of the loss
- Inquiring about both partners’ efforts at adjustment and difficulties in grieving
- Examining unhelpful beliefs and behaviors
- Supporting the couple’s efforts to share emotional tasks of grieving and recovery
- Validating emotions and the difficulty of the loss, especially when it involved making difficult life and death decisions
- Normalizing grieving and giving couples a “road map” of what to expect in terms of reactions for themselves and others
- Anticipating and coaching how to handle awkward, hurtful reactions from co-workers, friends, relatives
- Assessing strengths and availability of supportive resources in extended family, friendship network, professional community, faith community
- Facilitating the couple’s attempt to make meaning out of the crisis
- Exploring spiritual tools and creating meaningful rituals of memorial to their unborn child
- Encouraging action steps that promote healing, such as making a contribution to help others in a meaningful way
- Following and monitoring mental and physical health in the subsequent year, anticipating trouble spots, anniversary dates, loyalty issues
- Supporting the couple’s efforts to resume a normal life: restoring fun activities together, pursuing conception or adoption options, and new directions
Resources
The following are some useful resources for couples experiencing pregnancy loss:
Beyond Prenatal Choice , 1990. Centering Corp., 1531 N. Saddle Creek Rd., Omaha, NE 68104-5064, (402) 553-1200. A booklet for the family who chooses to terminate their pregnancy written by genetic counselors.
Internet Sites:
Books:
- Kluger-Bell, K. (1998). Unspeakable Loss: Healing from Miscarriage, Abortion, and Other Pregnancy Loss. New York: Quill. Also includes list of resources.
- Minnick, M.A., Delp, K.J., Ciotti, M.C. 4 th edition (1999). A Time to Decide, A Time to Heal: for Parents Making Difficult Decisions About Babies They Love. St. Johns, Michigan: Pineapple Press. Also includes list of resources.
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The opinions expressed in this article are those of the writer, and do not necessarily reflect those of the National Association of Social Workers or its members.
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Introduction
Over the past few years, Alzheimer’s disease screening tests have become available to consumers. Licensed clinical social workers who have special training in genetic counseling can help individuals or family members who are interested in these tests. Below is a fact sheet from the Alzheimer’s Association briefly describing the various screening tests.
What is a Screening Test?
A screening test is a preliminary procedure administered to distinguish individuals who may need further evaluation for a disorder from those who are less likely to need additional testing. Familiar examples of screening tests include Pap smears, mammograms, and kits for collecting small stool samples to be examined for hidden blood. Most such tests are administered under the supervision of a health care professional who orders the test, communicates the result, and discusses appropriate next steps.
What Screening Tests Are Marketed Directly to Consumers?
Test developers, health care facilities, and other sources are marketing a growing number of screening tests directly to consumers. Some of these tests are offered on a "self-referred" basis—individuals taking the test do not need a physician's order for it, and the testing facility reports the results directly to the examinee. Self-referred testing is a controversial practice. It is lucrative for facilities administering these tests because consumers must pay for them directly. Insurance plans generally do not pay for self-referred procedures, so facilities offering them can set their own price and require payment in advance.
What Consumer Screening Tests Are Marketed for Dementia?
The Alzheimer's Association has received numerous questions about two dementia screening tests recently marketed directly to consumers. One is the Early Alert Alzheimer's Home Screening Test, available in pharmacies and from a Web site. The other is the Minnesota Cognitive Acuity Screen (MCAS), sold by telephone and through a Web site.
The Alzheimer's Association believes that no single dementia screening procedure is a meaningful substitute for established diagnostic criteria for Alzheimer's disease administered by a skilled physician. Although these screening tests do not claim to offer a definitive diagnosis, any test that may plant the idea of a serious illness in a test-taker's mind has the potential to cause great psychological distress. The whole process of assessment, diagnosis, and diagnostic disclosure should be carried out within the context of an ongoing relationship with responsible health care professionals. Here are some relevant facts about each of the tests currently generating frequent questions:
Facts about the Early Alert Alzheimer's Home Screening Test
- This test, marketed by FMG Innovations, Inc., sells for around $15 – $20 in pharmacies and on the Internet.
- It is packaged in a small box that contains an instruction sheet, a pencil, and a booklet with 12 "scratch and sniff" odor strips. Examinees are instructed to scratch each strip to release the smell, then circle one of four words that best describe the odor. Choices include "cinnamon," "dog," "soap," "garlic," "motor oil," fruit and floral fragrances, and a variety of other scents.
- Correct answers are provided in an answer key at the back of the booklet. Examinees with four or more incorrect choices are advised to consult their physician.
- The instruction sheet states, "Smell loss is among the first signs of Alzheimer's disease. Experts recommend screening for smell loss once a year after the age of 65." It is true that there are legitimate scientific investigations exploring a possible link between smell loss and Alzheimer's disease, but the relationship has not been confirmed or quantified. No currently accepted diagnostic criteria for Alzheimer's include evaluation of smell, and there is no recommendation for annual smell testing from any recognized authority involved in establishing clinical guidelines.
- Many factors other than Alzheimer's disease can impair smell, including current smoking or past smoking, certain drugs, a wide variety of medical conditions, and individual differences in sensitivity to odors.
- Medical and diagnostic equipment, including products marketed directly to consumers, is regulated by the Center for Devices and Radiologic Health (CDRH) of the U.S. Food and Drug Administration (FDA). According to a CDRH spokesperson, the Early Alert smell test has not been cleared or approved for marketing.
Facts about the Minnesota Cognitive Acuity Screen (MCAS)
- The MCAS is sold by telephone and over the Internet for $95 by Nation's CareLink, a care management firm specializing in geriatric assessments.
- The test consists of a 15-minute question-and-answer telephone interview administered by a registered nurse who asks test-takers such questions as their name, address, and birthday, what day it is, and how they would handle an emergency such as a fire in their home. Examinees are also asked to repeat a six-digit number, to remember 10 words, and to tap on the telephone when instructed. Nurses score each examinee, and those whose scores fall below certain levels are considered to need monitoring or to have "failed" the test.
- The test's developers recommend annual testing. This recommendation does not reflect a policy established by any recognized clinical guideline.
- The chief use of the MCAS has been for commercial rather than clinical purposes—the test was developed by Nation's CareLink as a risk management tool to help insurers avoid issuing long-term care policies to individuals judged likely to develop dementia.
- The MCAS Web site describes the test as "98.1 percent effective in identifying cognitive function." In support of this statement, MCAS cites an article published by the test's developers in the October 2000 edition of the journal Neuropsychiatry, Neuropsychology, and Behavioral Neurology. The abstract of this article on PubMed, the on-line literature database for the U.S. National Library of Medicine, concludes with the developer's own statement that "The Minnesota Cognitive Acuity Screen (MCAS) should undergo further study in unselected elderly populations to better understand its value as a screening tool." The PubMed database contains no additional articles about the test.
Where Can I Get Information About Other Alzheimer-Related issues?
To receive information about other important issues related to Alzheimer's disease, please call our Contact Center at (800) 272-3900 or visit the Alzheimer's Association Web site at www.alz.org.
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KidsHealth for Parents, Genetic Counseling
KidsHealth is the largest and most visited site on the Web providing doctor-approved health information about children from before birth through adolescence. Created by The Nemours Foundation’s Center for Children’s Health Media, the award-winning KidsHealth provides families with accurate, up-to-date, and jargon-free health information they can use.
http://kidshealth.org/parent/pregnancy_newborn/medical_problems/genetic_counseling.html
National Society of Genetic Counselors
The mission of the National Society of Genetic Counselors is to promote the genetic counseling profession as a recognized and integral part of health care delivery, education, research and public policy.
www.nsgc.org
Partnership for Parents
The Partnership for Parents is a Web-based support network for parents of children with serious illnesses. The organization’s Web site is designed to be a haven where parents can feel the solace of kindred spirits while finding the information they need to cope with their situation and navigate their difficult journey.
www.partnershipforparents.org
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A Social Work Pioneer John E. Davis knew when he was growing up that he “didn’t want to be a teacher or a preacher,” but in a way he combined the two when he became a social worker.
He decided on his career path even before he entered Michigan State University, where he earned a bachelor’s and a master’s degree in social work.
He moved to Dallas in 1959 to work in the mental hygiene clinic at the Veterans Administration Hospital.
Davis Honored by the National Association of Social Workers The National Association of Social Work honored Mr. Davis earlier this year as a pioneer, and recently he was recognized by the group’s Dallas branch for having joined the National Association of Social Work when it was formed 50 years ago this year.
“John Davis has been a driving force in helping the social work profession in Texas,” said Martha C. Jarmon, chairwoman of the Dallas branch and the family resource specialist at Texas Scottish Rite Hospital for Children.
“He helped move social workers through the often difficult process of obtaining first certification and then licensure and has been truly a leader and a true pioneer for the profession in Texas,” she said.
Mr. Davis started social work a couple of years before the National Association of Social Work was formed.
“Social work at the time was looked on as government employees doling out charity,” said Mr. Davis, whose first job in the field was at an old-age assistance program in Lansing, Mich.
There was a shortage of good mental health professionals then, he said, so the private sector wanted him and other social workers to provide most of the services.
“A diploma on the wall didn’t tell it all. Though many psychiatrists and psychologists charged more than a social worker, many social workers were as skilled in dealing with family relationships – and offered the service much cheaper.”
Stopping the Pattern – Genetics Can Cause Problems
Most social work problems are within the family, he said, “and within the family, genetics are often the cause of problems – a 16-year-old who gets pregnant like her mother did at that age, an abused child that will become an abusing parent. Our job is to interrupt the pattern.”
Mr. Davis worked on a test program in the early 1990s that the Child Guidance Clinic had with the Dallas County Juvenile Department.
“We were making home visits to families with delinquents,” he said. “You couldn’t get them to come to the office. So on Saturdays, Sundays and at nighttime, we would go to homes.”
And though it sounds incongruous, they were not always trying to save the delinquents in the family. Instead, they were trying to save their younger siblings.
Mr. Davis praised the program, which was stopped because of budget limitations. It used rehabilitation instead of punishment, he said, which brought better results.
Battle for Change
In a way, being involved in social work is a never-ending battle to achieve change.
He and others in the profession, for example, spent years lobbying to get insurance for their cases.
“Psychiatrists generally didn’t have any trouble getting insurance for their patients because they were medical doctors. Psychologists had some trouble, but social workers had a lot of trouble.”
Mr. Davis acknowledges that the most severe cases tend to get picked up by agencies such as Child Protective Services and Adult Protective Services. “They do a lot of the hard work,” he said.
“I went to private practice because of the freedom that is not available in agencies.
“I could maintain my own agenda.”
Private Practice and More Mr. Davis started private practice after three years at the VA Hospital.
But he found time to work at agencies as well. He taught family and marriage classes at Texas Woman’s University and did consultation work at Terrell State Hospital.
“I felt the reason that I was able to make a greater impact here is that Dallas wasn’t flooded with social workers, a situation that means a goodly portion of the population was underserved.”
If he had his way, Mr. Davis would like to have social service clinics in every community in the city, rich and poor, because there are drug addiction and other mental health problems communitywide.
He also says with candor that “Dallas is still not a place to be poor. If you’re in Dallas, to be poor is considered an indication that you have a character flaw.”
Sounds a little like a preacher, a little like a teacher, but mostly like a social worker.
Reprinted with permission from The Dallas Morning News
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