Judy MacDonald Johnston’s 5 Step Plan to Die Well

By: Mindy Barnes

Death is a difficult subject to discuss, especially when the death is our own. Many of us avoid the topic all together until it is too late.  But like it or not, death is inevitable. According to Judy MacDonald Johnston, planning for your end of life is a very important process. It will not only help you die well, it will also help you to maintain a high quality of life right up to the very end. For those of us who are finally coming to terms with our own mortality but don’t know how to begin the planning process–or those of us who still need to be dragged kicking and screaming–Judy has some tips to help. Here are Judy MacDonald Johnston’s 5 practices to help you prepare for your end of life:

#1. The Plan

Here are some questions to help you begin your end of life plan. Who do you want as your power or attorney, and your medical power of attorney? Where would you like to go if/when the time comes when you are no longer capable of performing activities of daily living? Do you want your family to follow the palliative care outlined by a hospice program? How do you feel about physician-assisted suicide? Do you or do you not want the following extension of life procedures administered: CPR, feeding tube, surgery, breathing machine, antibiotics, etc.? These are all questions that you need to answer and have a plan for.

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#2. Advocates

Your advocates are there to communicate with others (medical teams, family members, etc.) what your wishes are in regard to your end of life care when you are no longer able to do so yourself. You want to make sure that you choose the right person(s) to ensure that you get the end that you want. Advocates should have the time and the ability to handle this important, yet at times stressful and emotional, task. A good advocate may have the following attributes: adapts well to change, keeps calm under pressure, has good people skills, is not afraid to ask questions. Before choosing an advocate(s), make sure to have an open conversation with them and be sure that they agree to be your advocate.

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#3. Hospital Readiness

Prepare a Medical Emergency Packet. This packet should include a summary of your medical information, and copies of important documents such as your ID, insurance cards, Durable Power of Attorney for Medical Decisions, and Do Not Resuscitate Order. Give a copy of this packet to your advocates and keep yours in an easy to access place This will make admission to the hospital quick and less stressful, and will reduce risks of treatment errors.

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#4. Caregiving Guidelines

Do you want to live in an assisted-living community, or would you prefer to stay at home and hire a professional caregiver? Determine what is a best fit for your personality, but also what you can afford. Do not settle either. You should not rush your decision. Take the time to find your perfect match.

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#5. Last Words

During your last days/hours, you may not be able to speak. So, it is important that you decide now what you would like to hear from others. You may want to be reassured that everything will be fine, so let others know what you may be worried about. Also, write a list of who you will want to see during your last days. And if you follow all of these practices, you will hopefully be able to die with peace of mind.

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Social Work and Mental Health: Working with Special Groups

By: Mindy Barnes

According to DiNitto and McNeece, “[m]ental health is the largest area of social work specialization, and social workers are the largest group of mental health practitioners in the United States (National Association of Social Workers, 2006)” (2008, p. 145). Social workers employed in the mental health field may work in a variety of different arenas, such as in hospitals, residential programs, and private practice. However, it isn’t just where they work that differs but who they work with. Below is a list of four specific consumer groups that social workers help:


#1. Children and Adolescents

One half of all mental disorders manifest by age fourteen (DiNitto & McNeece, 2008, p. 153). This fact alone would suggest that addressing the mental health needs of children and adolescents should be the primary concern of mental health professionals. Unfortunately, mental health services for children are lagging far behind those for adults. Social workers assist children of all ages, but they often try to identify those with mental illness or developmental problems as early as possible. Factors, other than biology, that increase a child’s risk for developing mental disorders include: physical, sexual, or substance abuse, running away from home, abusing others, family violence, having a caregiver or sibling who has been institutionalized or who has a felony conviction of substance abuse problem (DiNitto & McNeece, 2008, p. 153).


#2. Dual Diagnosis Consumers

Many individuals with mental health problems have co-occurring disorders, such as substance abuse and medical problems. Having co-occurring disorders makes getting the proper treatment even more difficult. According to DiNitto and McNeece, “[i]deally, treatment agencies provide integrated treatments that address SMI, substance abuse, and medical problems simultaneously, but in many states, integrated programs are in their infancy, and consumers must go from agency to agency in what is a fragmented service delivery system” (2008, p. 154). Social workers usually work as part of a professional team, which includes physicians and nurses, and often conduct home visits to better understand the clients’ biopsychosocial conditions. Treatment techniques for these individuals can include: medication, education and outreach, peer support, and behavior therapy (DiNitto & McNeece, 2008, p. 154).


#3. Homeless Individuals


Roughly 25 percent of those who are homeless have a serious mental illness, and about one half of these individuals also have co-occurring disorders (DiNitto & McNeece, 2008, p. 154). Homeless families are a rapidly growing population, and “[s]eventy-six percent of homeless children have a mother who has major depression, schizophrenia, a substance use disorder, or high distress (Hicks-Coolick, Burnside-Eaton, & Peters, 2003)” (DiNitto & McNeece, 2008, p. 155). These children also tend to show signs of mental health problems. Social workers may provide mental health services in homeless shelters, or they may be part of an assertive community treatment (ACT) team that delivers services to the homeless out on the streets.


#4. Military Personnel

Military personnel, especially those in combat, can experience mental health problems, such as post-traumatic stress disorder, and often have co-occurring disorders, such as substance abuse. Also, “[m]ilitary personnel and their families can face a pileup of stressors that puts them at risk of dysfunction, including moving often; adapting to living in other countries; episodic or long separations; and, during wartime, the fear of death or disability (Black, 1993)” (DiNitto & McNeece, 2008, p. 155). Social workers, many of whom are employed by the VA, help by addressing child abuse and IPV, and by providing mental health services and substance abuse treatment. Social workers can be, but are not required to be, military personnel themselves.


Whether you are a social worker or not, please remember that:


DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a challenging profession (3rd ed.). Chicago, IL: Lyceum Books.


Four Reasons Why Children Need Social Workers To Be Their Super Heroes

By: Mindy Barnes

Social workers have a long history of working with children and families, and it is very important work, indeed. According to Rittner and Wodarski, “'[c]hild welfare’ generally refers to a broad range of services provided by agencies charged with maintaining legally mandated or socially sanctioned standards of safety and well-being for children” (1999, p. 217). But what is it that threatens the safety and well-being of children that renders child welfare as performed by social workers necessary? Below are four examples of life circumstances and events that social workers help shield children from:





#1. Child Abuse and Neglect


According to DiNitto and McNeece, “[n]eglect (the failure of adults to meet children’s physical, emotional, mental, educational, or social needs) accounts for 52 percent of the approximately one million cases of child maltreatment verified each year in the United States” (2008, p. 239). Of those cases involving abuse, 25% involve physical abuse, 12% sexual abuse, and the rest emotional or psychological abuse (DiNitto & McNeece, 2008). Social workers must be able to determine the type of maltreatment, its causes and effects, and how to help.


#2. Poverty


Children living in poverty are at greater risk for maltreatment. DiNitto and McNeece point out that, “[i]n the United States, 13 million or nearly 18 percent of children live in poverty, and children of color are at elevated risk of poverty (DeNavas-Walt, Proctor, & Lee, 2006)” (2008, p. 240). Poverty can negatively affect the health and well-being of children in many ways. It is important that social workers understand these effects, as they are likely to work with many children and families from lower socioeconomic statuses.


#3. Trauma


Some children have gone through traumatic events which has left them with, sometimes permanent, scars. Such scars can include, “cognitive dysfunction (such as impaired memory), hypervigilance (a heightened state of fear), recurrent memories of the trauma, emotional numbing, aggressive responses, or limited future orientation (Steele, 2004)” (DiNitto & McNeece, 2008, p. 240). Trauma can also be caused by abuse and neglect, which can have serious negative effects on a child’s mental health. Social workers can help families and children cope with and overcome these effects in a variety of ways.


#4. Substance Abuse

According to DiNitto and McNeece, “[a]n estimated 67 percent of parents involved with the child welfare system abuse drugs and/or alcohol (Child Welfare League of America, 2001)” (2008, p. 241). And substance abuse can lead to child maltreatment. What often happens is that children with parents who have drug or alcohol problems will end up having to function as parents themselves. It is up to social workers to offer an array of services in order to get the children and parents the help they need.





The work that child welfare social workers do to keep children safe and healthy is invaluable not only to the children that they help, but to the whole of society. As DiNitto and McNeece put it, “[w]orking with and for children is an investment in the future of humanity” (2008, p. 259). Children of all races, genders, ethnicities, religions, and socioeconomic statuses can be victims of maltreatment. It is important for social workers to consider the biopsychosocial conditions that affect these children, and to also use empowerment-based practices in order to give children a voice while also maintaining their safety.




DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a challenging profession (3rd ed.). Chicago, IL: Lyceum Books.

Rittner, B., & Wodarski, J. (1999). Differential uses for BSW and MSW educated social workers in child welfare services. Children and Youth Services Review, 21(3), 217-235.

Why ALL Social Workers Need To Understand Substance Abuse

By: Mindy Barnes



Although only a small percentage of the social work population—roughly 3 percent—focus primarily on substance abuse, “nearly three-quarters of NASW members report having helped a client with an alcohol or drug problem in the last year (O’Neill, 2001)” (DiNitto & McNeece, 2008, p. 171). This is because substance abuse can affect anyone and everyone. It does not discriminate based on age, gender, race, sexual orientation, or socio-economic status. Social workers in the fields of health care, child welfare, domestic violence, and military and veteran affairs often work with individuals who have substance use disorders. Here are a few other reasons why social workers in all areas should be trained and competent in the diagnosis and treatment of substance abuse:




#1. Mental Health


The majority of those with a substance abuse disorder also have a mental illness. The goal of social workers who are working with individuals with dual diagnosis should be two-fold: “1) assess and diagnose the mental health issue and 2) address the addiction” (Grobman, 2012, p. 216). This is a complicated task. It is often difficult to determine if the mental illness preceded the addiction or vice versa, if the mental illness is a substance-induced disorder, or if the two are coexisting conditions. Unfortunately, as Doweiko points out, “only 8% of MI/CD patients received treatment for both disorders in the preceding 12 months, and 72% received no treatment at all (Prochaska et al., 2005)” (2009, p. 281). Thus, it is imperative that social workers recognize and treat both of the factors–substance abuse and mental illness–that are each affecting the client in different ways.


#2. Homelessness


Doweiko mentions that, “[r]esearchers have found that 45% to 78% of those who are homeless have a substance use disorder (Arehart-Treichel, 2004; Smith, Meyers, & Delaney, 1998)” (2009, p. 255). They may have become homeless as a result of their addiction, or their addiction may be a result of their trying to cope with being homeless. Social workers can help these individuals, “locate more permanent shelter in a halfway house or other residential program, find a job, apply for food stamps, and get health care from a free clinic and substance abuse and mental health care from a community mental health center of similar program” (DiNitto & McNeece, 2008, p. 183). Social workers should also recognize that this population faces the dual stigma of being homeless and being an addict.




LGBTQ individuals are more likely to have a substance use disorder than non-LGBTQ people. It is also important to remember that they are at greater risks for contracting and transmitting HIV through higher rates of substance abuse. For social workers, “[t]o understand substance use disorder (SUD) among lesbian, gay, bisexual, and transgender (LGBT) people, a number of environmental concerns need to be examined, namely, the state of the research on SUD in the LGBT communities, the adequacy of training of health care providers about LGBT health, and the impact of systematic oppression on LGBT communities in terms of disparate levels of psychosocial distress, violence, and access to health services” (Silvestre, Beatty & Friedman, 2013, p. 366). LGBTQ individuals with substance abuse disorders are particularly vulnerable in that they are already marginalized for their LGBTQ status, but on top of this are faced with the stigmas surrounding substance abuse.


#4. Criminal Justice


There is much debate as to whether it is substance abuse that contributes to criminal activity or vice versa, or if the two are even related other than substance abuse being an illegal activity. However, it is a major problem that, “less than 15% of inmates with a substance use disorder (SUD) receive some form of treatment for their SUD while incarcerated (Aldhous, 2006)” (Doweiko, 2009, p. 428). These individuals are then sent back out into streets, still suffering from an SUD or even a mental disorder, usually with no money, and are expected to successfully reintegrate back into society. This lack of awareness (or concern) about the problems these individuals face on behalf of the criminal justice system on the one hand, and the inability of physicians and other professionals to properly address these problems on the other, only perpetuate this vicious cycle (mental disorder-substance abuse-homelessness-incarceration). It is up to social workers to advocate for social justice.





While I focused on alcohol and drug addiction here, it is also important to remember that there are many other types of addiction. Different forms of addiction can include, “gambling, overeating, sex, internet use, and shopping,” and many often co-occur (DiNitto & McNeece, 2008, p. 171). It is also important for social workers to think about what causes substance abuse and how other factors come into play in order to properly diagnose and treat individuals with a substance abuse disorder. They need to, “consider whether and how biological, sociological, and psychological factors may contribute to an individual’s addictive or impulse-control disorders” (DiNitto & McNeece, 2008, p. 178). The field of addiction needs social workers to promote social justice, create effective practice, and take a holistic, strengths-based approach in working with individuals who have addictive disorders.





DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a challenging profession (3rd ed.). Chicago, IL: Lyceum Books.

Doweiko, H. E. (2009). Concepts of Chemical Dependency (7th ed.). Belmont, CA: Brooks/Cole Cengage Learning.

Grobman, L. (2012). Days in the Lives of Social Workers (4th ed.). Harrisburg: White Hat Communications.

Silvestre, A., Beatty, R., & Friedman, M. (2013). Substance Use Disorder in the Context of LGBT Health: A Social Work Perspective. Social Work in Public Health, 28, 366-376.

Six Ways the Vet Center Can Help YOU!

By: Mindy Barnes


The U.S. Department of Veterans Affairs (VA) is the number one employer of social workers in the United States. The VA employs over 11,000 social workers in service to the roughly 2 million veterans living in the U.S. (John Vassello, 03/08/16, Class PowerPoint). The priority of military social workers employed at Vet Centers is to assist these war zone veterans of all eras, including: World War II, Korean War, Vietnam War, Persian Gulf, and the Global War on Terrorism, among many others. If you are a veteran, here is what the Vet Center can do for you (all the information below was gathered from Connie Studgeon’s guest lecture and the materials she provided):


#1. PTSD

Posttraumatic Stress Disorder is common among military members who have been through a traumatic event, such as combat. Some symptoms include: reliving the event through flashbacks, avoiding situations that remind you of the event, negative changes in beliefs and feelings, feeling keyed up (hyperarousal), and a long list of related complications like depression and anxiety. Spouses and children may also experience secondary PTSD. Vet Center staff help PTSD sufferers learn to cope with or lessen the effects of PTSD through utilizing the various psychotherapy techniques or through medication.


#2. Sexual Trauma and Harassment Counseling

The military is still largely a man’s world, sometimes making life very difficult for female military personnel. But sexual assault and harassment can happen to veterans of both sexes. Spouses of veterans can also be victims of sexual trauma and harassment. The Vet Center offers individual and group readjustment counseling, sexual trauma counseling, referral for benefits assistance, and liaison with community agencies, along with other services (discussed below) designed to help with the trauma or its side effects.


#3. Group and one-on-one counseling

The Vet Center also provides individual and group counseling for anger management, alcohol and/or drug problems, depression and anxiety, and social problems. Vet Center staff include wonderful social workers like Connie Studgeon, LCSW-R, from the Binghamton Vet Center who provide nonjudgmental and supportive therapy to vets in need. Sometimes just having someone who is willing to listen can make all the difference.


#4. Marital and family counseling

The families of military members are also affected by war. The military family member may be suffering from PTSD or sexual trauma, which can have negative effects on spouses and children. These effects may include secondary PTSD, marital troubles, or abuse. The best way to help veterans is through helping the whole family.


#5. Bereavement Counseling

Death is an unfortunate aspect of war. All too often veterans return home having lost many friends, while others do not return at all. Bereavement counseling is offered to military personnel, as well as to parents, siblings, spouses and children of military personnel who have died in the service to our country.


#6. Other programs and services

The Vet Center also offers a variety of other services such as parenting classes, benefits and job counseling, and even meditation and yoga classes. Vet Center staff are concerned with the health and well-being of the mind, body and soul of all veterans. They also respect rights to privacy, and all services are completely confidential.


If you are yourself a veteran, or if you are a family member of a vet, and would like to learn more about what the VA and Vet Center can do for you, you can visit www.vetcenter.va.gov for more info. If you live in Broome County, you can contact the local Binghamton Vet Center at (607) 722-2393. Remember, if you are experiencing any problems related to your combat zone experience, you are ­not crazy and you are not alone. You do not have to live at the mercy of these problems, and you have the strength and the ability to take back control over your life. The sooner you contact the Vet Center the better the outcome, but it’s never too late to seek help. Thank you all for your service.



Pamphlet (Binghamton Vet Center), information sheets (War Zone Veteran Eligibility, and “What is PTSD?” found at http://www.ptsd.va.gov), and lecture provided in class by Connie Studgeon, LCSW-R, Binghamton Vet Center, 03/10/16.

Vassello, John. 03/08/16. Class PowerPoint.

4 Reasons Why Leadership in Social Work is Under Attack Part 2: Social Work in Health Care

By: Mindy Barnes


Medical social workers are vital members of the health care profession. These social workers are often the only health care professionals able to assess and address all of the client’s biopsychosocial needs. Unfortunately, few social workers hold leadership positions within health care settings. Before are four reasons why:


#1. Reengineering of the 1990s was a major threat to medical social work leadership, as decentralization took supervisory positions away from social workers. And according to Judd and Sheffield, “[a]s social work leadership began to evaporate and free standing departments were absorbed into case management units, hospital social workers were placed into a position of competing for roles they had historically filled” (2010, p. 858). Today more than ever, patients are in need of social workers, and social workers are gaining back their valued positions within health care settings. However, social workers are still missing from prominent leadership roles. 

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#2. Social work leadership is overlooked by professionals at all levels. DiNitto and McNeece say that, “[s]ocial workers are taught to place a high value on collaboration, whereas physicians are generally taught to assume leadership roles in interdisciplinary groups (Mizrahi & Abramson, 1985)” (2008, p. 206). Interdisciplinary collaboration is certainly an important aspect of social work, but perhaps social workers could also learn to incorporate leadership styles into their practice within health care settings. Also, “[a]s in other important areas of social welfare policy, social workers have generally not been at the table when government or proprietary health-care organizations have made important policy changes in health-care programs. Social work’s multilevel perspective provides an important point of view that should be considered in any major policy shift” (DiNitto & McNeece, 2008, p. 214).


#3. According to Liechty, “[d]espite the extensive knowledge and skills that social workers can bring to bear to assist patients with low health literacy, the concept of health literacy is underused in social work scholarship. This gap reflects missed opportunities for social workers to contribute their expertise to the evolving field of health literacy and to strategically align their work with organizational and national priorities” (2011, p. 99). The disconnect between health care providers and patients with low health literacy often leads to patients being referred to social workers, as social workers are highly equipped to deal with this vulnerable population. Unfortunately, health literacy terminology is rarely used within social work literature, which can hinder social workers’ ability to become leaders and advocates in health care settings (Liechty, 2011).

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#4. DiNitto and McNeece point out that, “[s]ome of the struggles social workers experience in the medical field can be attributed to the various ideas other medical professionals have concerning what constitutes medical social work” (2008, p. 194). The fact that medical social work encompasses a variety of roles is beneficial in that it allows social workers to assist and advocate for patients in many different areas within the medical field. However, because medical professionals differ in their ideas of what a medical social worker’s purpose should be, social workers could lose out on important leadership positions within medical settings.

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Ida Cannon, the first identified medical social worker, said that medical social work, “strives to bring to the institutionalized care of the sick such personal and individual attention to the patient’s social condition that his recovery may be hastened and safeguarded” (DiNitto & McNeece, 2008, p. 193). Cannon’s words still hold true today. The patient’s health and well-being is the sole concern of medical social workers. So, it only makes sense that patients and medical professionals at all levels would benefit from having social workers fulfill leadership roles. To accomplish this, social work programs could promote the integration of leadership skills with interdisciplinary collaboration, and they could acknowledge the importance of addressing health literacy and evidence-based approaches within the academic literature. Also, all health care organizations should recognize the necessary work and specific knowledge provided by medical social workers, as well as the potential benefits of having social work leaders within their facilities.



DiNitto, D., & McNeece, C. (2008). Social work: Issues and opportunities in a challenging profession (3rd ed.). Chicago, IL: Lyceum Books.

Judd, R., & Sheffield, S. (2010). Hospital Social Work: Contemporary Roles and Professional Activities. Social Work in Health Care, 49(9), 856-871. doi:10.1080/00981389.2010.499825

Liechty, J. (2011). Health Literacy: Critical Opportunities for Social Work Leadership in Health Care and Research. Health & Social Work, 99-107.