Dawn Joosten: My Path to Researching Loss and Bereavement

The Study of Loss and Bereavement

I chose to work in the field of social work for several reasons. I knew that I was interested in working with older adults because of a volunteer experience and internship at Leisure World as an undergraduate psychology student. During that time, I sought mentorship from two social work faculty members whose advice confirmed my decision to pursue graduate training in social work. Rather than focusing on just the intrinsic aspects of an individual, social work incorporates aspects of an individual’s social environment that I recognized as important in helping individuals and families: external environmental (micro, mezzo, macro), societal/historical, culture, diversity, spirituality, mental and physical health, developmental, etc. Additionally, the values and ethics within the social work profession set forth by the NASW were consistent with how I envisioned a social worker to be an agent of change who improves life circumstances and opportunities for individuals, families and communities through advocacy at micro, mezzo and macro levels.

My interest in loss and bereavement developed during my professional career as a licensed clinical social worker at Providence Health Services. In my area of specialization in working with disabled and older adults with chronic and life-threatening illnesses, I began to recognize that loss and, often times, multiple losses are at the heart of each encounter with the client and family system. Whether it is an older adult who has had a hip replacement and is adjusting to temporary changes in functional health during rehabilitation, an adult who is diagnosed with Parkinson’s disease faced with declining functional health over time, an adult or older adult diagnosed with a terminal disease, or a child or grandchild adjusting to being a caregiver to an aging parent or grandparent, each encounter involves loss with which the individual and family are faced.

My Research

In my graduate training, I conducted research to examine the differences in the perceptions of discharge needs between older adults at a skilled nursing facility and their nurses. A key finding was that older adults perceived their need for assistance with activities of daily living and instrumental daily activities of living lower than their nurses did. This has important implications for social workers to facilitate discussions with older adults about such discrepancies to ensure their safety upon discharge to prevent recidivism. It is also an opportunity for an older adult to process the loss(es) that may be affecting their perceptions of their needs. In my doctoral research, I examined social work decision-making in providing functionally dependent older adults discharged from acute care to community care settings with home and community-based services to meet their psychosocial and physical needs once they returned home. Most older adults were provided with services for transportation, caregivers, home-delivered meals, emergency response pendants and information/education on diseases, and a high proportion of older adults accepted these service referrals. I also examined whether the older adults accepted assistance from the social worker at the time of the home visit. Most older adults did not implement services at the time of the visit. An implication for the role of social workers is to assess grief and loss reactions during the biopsychosocial spiritual and cultural assessment. This not only informs the treatment planning and interventions with the client; it also provides an opportunity for the older adult’s experience and feelings to be validated. Often times, changes in health are disenfranchised types of grief as family members, friends and society often discount their reactions because failing health is expected in this developmental stage. Social worker’s with training in grief and loss can provide therapeutic interventions to allow an older adult to process primary and secondary losses which occur as a result of changes in health. Grief and loss work may occur simultaneously with other aspects of the treatment plan such as advance care planning and/or resource coordination.

My Hope for My Students

It is my hope that all of my students take away a desire for lifelong learning; a passion for social justice and advocacy; a commitment to culturally competent practice; and competencies to inform their clinical practice through research, policy, theory and advanced assessment. With the changing structure of the health care system brought on in part by the Affordable Care Act, a holistic approach to advocacy and the ability to work with multiple providers across systems of care will be increasingly important skills for social workers. Social workers in health settings will need ongoing training in grief counseling and grief therapies, behavioral health, integrated care, and health prevention and promotion models of care. It is also my hope that students will have a passion to become leaders in their organizations and communities and/or at legislative levels, and to build the knowledge base of our profession through scholarship activities.

You can learn more about Dawn Joosten on her Faculty Directory page.