SWK205- SOCIAL WORK WITH THE ELDERLY  TOPIC: Lesson 7 Substance Use in Older Adults Lesson 7 Discuss

Jean Galiana &
William A. Haseltine

Solutions to the Most
Pressing Global

Challenges of Aging

Aging
Well

Aging Well

Jean Galiana • William A. Haseltine

Aging Well
Solutions to the Most Pressing Global

Challenges of Aging

ISBN 978-981-13-2163-4 ISBN 978-981-13-2164-1 (eBook)
https://doi.org/10.1007/978-981-13-2164-1

Library of Congress Control Number: 2018962361

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Singapore

Jean Galiana
Vital Research
Los Angeles, CA, USA

William A. Haseltine
ACCESS Health International
New York, NY, USA

v

This book is a product of ACCESS Health International (www.accessh.
org). ACCESS Health is a think tank, advisory group, and implementa-
tion partner dedicated to assuring that everyone, no matter where they
live and no matter what their age, has access to high-quality affordable
healthcare. ACCESS Health works in low-, middle-, and high-income
countries. In high-income countries, our focus is on care of older adults
and those with dementia. This book identifies and analyzes policies and
practices in the United States that serve as models of excellence in elder
care and optimal aging. We chose the title Aging Well because we believe
that well-being should be the number one focus of all aging care, sup-
ports, and interventions. A companion book Aging with Dignity exam-
ines similar topics in Sweden and several Northern European countries.

Our method was to identify organizations in the United States that
exemplify the best in elder care and optimal aging. We then interviewed
the leaders and champions of those organizations and programs. The full
text of the interviews is available on the ACCESS Health website or at
this link: www.accessh.org/agingwell. Here, we analyze our findings and
present them in the broader context of elder and dementia care and social
inclusion. Our focus areas include long-term care financing, person-
centered care, coordinated primary care, home-based palliative and pri-
mary care, support for those living with dementia and their caregivers,
acute and emergency care in the home and community, the combination

Preface

vi Preface

of health and social care that addresses the social determinants of health,
and housing, social inclusion, purpose, and lifelong learning.

From these interviews we abstract eight key lessons for achieving high-
quality affordable elder care and effective systems that support social
inclusion and purposeful aging. Those lessons are:

• The availability of affordable long-term care insurance is essential to
improve access and sustain the costs of caring for older adults.

• Person-centered care is a lynchpin of high-quality care and well-being
for older adults.

• Support and palliative care in the home and community setting is
essential for making care accessible to older adults that honors their
care and late-life priorities.

• Coordinated primary healthcare improves elder care quality and acces-
sibility and lowers healthcare costs.

• It is imperative that we build systems of support and inclusion for
those with dementia and their caregivers.

• Delivery of acute and hospital-level care in the home and community
is essential to lower healthcare costs and improve access, health out-
comes, and well-being for older adults.

• Social inclusion and the opportunity to live a purposeful life are essen-
tial to the happiness and well-being of older adults.

• Combining health and social care with upstream interventions to treat
the biopsychosocial and environmental needs is the way forward to
sustainable systems of care that improve function, well-being, and
independence.

The book identifies and details global aging challenges and, chapter by
chapter, offers innovative and impactful solutions to those challenges that
our interviewees have designed. It is our genuine hope that providers and
government entities around the globe that are seeking methods to improve
their elder care and social support systems will find ideas, inspiration, and
possibly collaborative opportunities to enhance the well-being of older adults.

Los Angeles, CA Jean Galiana
New York, NY William A. Haseltine
July 2017

vii

We thank all those who contributed their time and thought to help us
understand the issues facing older adults and what can be done to ensure
that all have access to high-quality affordable care and the opportunity to
live productive and active lives.

Claude Thau patiently described the rocky history of the long-term
care insurance industry and why many still do not have long-term care
insurance today.

We learned the true meaning of patient-centered care culture from
Christopher Perna, the former CEO and President of the Eden Alternative.

Rebecca Priest from St. John’s explained how to build an operational
culture around person-centered philosophies.

The leadership of Beatitudes Campus brought the person-centered
concept to a new light with their Comfort Matters™ palliative care for
those living with dementia.

Dr. Allen Power made us think about the possibility of not segregating
those who have dementia from the rest of the community.

They all convinced us that person-centered communication and care is
almost always a better option than the use of antipsychotic medications
to meet the needs of someone living with dementia.

Dr. Allan Teel of Full Circle America, Dr. Diane E. Meier of the Center
to Advance Palliative Care, and Dr. Kristofer Smith of Northwell Health

Acknowledgments

viii Acknowledgments

inspired us with their dedication to enabling aging in place and where
patients receive the right care in the right setting and live with dignity
throughout their life.

Kristofer and Allan have been making house calls for all of their careers
because they know that it improves access to care, costs less, and signifi-
cantly contributes to the well-being of their patients.

Allan connects his patients to local supports and services so that his
patients stay engaged and connected to their neighborhoods.

Diane remains vigilant in her pursuit to make palliative care available
in all care settings.

Drs. Michael Barr and Erin Giovannetti of the National Committee
for Quality Assurance gave us a compelling case for the patient-centered
medical home to improve coordinated efficient primary care.

The Director of the James J.  Peters VA Medical Center, Dr. Erik
Langhoff, uses technology to improve access to high-quality care for
veterans.

Dr. Mark Prather and Kevin Riddleberger with DispatchHealth and
Dr. Kristofer Smith with Northwell Health are proof positive that deliv-
ering acute medical care in the home and community improves access
and quality at a fraction of the cost.

Dr. Bruce Leff with Johns Hopkins School of Medicine showed us that
providing hospital-level care in the home to patients who qualify can
reduce care costs and produce higher-quality health outcomes.

Timothy Peck, Garrett Gleeson, and XiaoSong Mu with Call9 are con-
tributing to the well-being of patients living in skilled nursing by provid-
ing technology-enabled emergency care and palliative care around the
clock.

Dr. Mary Mittelman with the NYU Caregiver Intervention has proven
the value of supporting the informal caregiver for someone living with
dementia.

Jed Levine and Elizabeth Santiago tirelessly support those in the early
stages of dementia and their caregivers with their vigorous programs at
CaringKind.

Davina Porock impressed upon us the importance of the built envi-
ronment of the hospital for those living with dementia.

ix Acknowledgments

Karen Love and Jackie and Lon Pinkowitz remind us of the vital
importance of fighting the stigma of dementia with thoughtful
community conversations. They also noted the importance of involving
those with dementia in policy and program design.

Brian LeBlanc shared his journey of living for dementia and his stories
about his impactful advocacy efforts.

June Simmons with the Partners in Care Foundation impressed upon
us the need to combine social care and healthcare and address social
determinants of health through evidence-based prevention programs.

Sarah Szanton with CAPABLE proved that it is possible to improve
function in frail older adults by providing home modifications with nurs-
ing and occupational care to support the goals and priorities of
participants.

Joani Blank invited us into her home at the Swan’s Market cohousing
community in Oakland, California. We spent a half-day seeing how
cohousing promotes community inclusion and multigenerational
connections.

Rebecca Priest with St. John’s and the management of Beatitudes
Campus regaled us with stories of resident-run activities that facilitate
productive living and generativity.

Anne Doyle surprised us with the amount of lifelong learning  and
intergenerational connections taking place at Lasell Village, a retirement
community on the campus of a college.

Mia Oberlink formerly  with the Center for Home Care Policy and
Research impressed the importance of involving older adults in the design
of all initiatives that serve them. Ruth Finkelstein formerly  with the
Robert N. Butler Columbia Aging Center and the International Longevity
Centre USA is committed to ensuring that employers who retain and
attract older employees are honored so others will follow suit. Ruth and
Dorian Block are combating the stigma of aging by telling the stories of
older adults who exceeded life expectancy in New York City and are liv-
ing vibrant productive lives.

Lindsay Goldman with Age-Friendly NYC expressed the need for
public and private partnerships to make environments accessible to those
of all ages and abilities. She explained that older adults must be consid-
ered in all areas of city planning and policy making.

x Acknowledgments

Emi Kiyota showed us how multigenerational community hubs con-
tribute to resilience after natural disasters and serve as places of produc-
tive engagement and social inclusion.

Dr. Paul Tang, formerly with the Director of the David Druker Center
for Health Systems Innovation, uses social connections as a form of
health prevention by connecting patients to a timebank where they
exchange tasks and teaching of hobbies and new skills.

Our research was supported by the William A.  Haseltine Charitable
Foundation Trust.

xi

ACCESS Health International is an independent, nonprofit think tank
that works for the provision of high-quality, affordable care for all, includ-
ing the chronically ill. Our method is to identify, analyze, and document
best practices in helping people and to consult with public and private
providers to help implement new and better cost-effective ways to offer
care. We also encourage entrepreneurs to create new businesses to serve
the needs of this rapidly expanding population. Our goal is to inspire and
guide healthcare professionals and legislative leaders in all countries to
improve care for their own people.

About ACCESS Health International

xiii

1 Demographics 1

2 Healthcare in the United States 7

3 Long-Term Care Financing 19

4 Person-Centered Long-Term Care 29

5 Home-Based Palliative Care and Aging in Place and
Community 59

6 Coordinated Primary Care 79

7 Emergency Medicine and Hospital Care in the Home and
Community 91

8 Support for Those Living with Dementia and Their
Caregivers 117

Contents

xiv Contents

9 Merging Health and Social Services 139

10 Purpose and Social Inclusion 159

11 Eight Lessons for Social Inclusion and High-Quality
Sustainable Elder Care 203

Index 217

xv

William A. Haseltine, PhD He is the Chair and President of ACCESS Health
International. He was a professor at Harvard Medical School and Harvard
School of Public Health from 1976 to 1993, where he was founder and the chair
of two academic research departments, the Division of Biochemical Pharmacology
and the Division of Human Retrovirology. He is well known for his pioneering
work on cancer, HIV/AIDS, and genomics. He has authored more than 200
manuscripts in peer-reviewed journals and is the author of several books, includ-
ing Aging with Dignity: Innovation and Challenge in Sweden and Affordable
Excellence: The Singapore Healthcare Story.

Jean  Galiana, MASM, RCFE In her role at ACCESS Health International,
Jean Galiana successfully promoted key messages about elder care and optimal
aging to engage policy makers, healthcare providers, the general public, and
stakeholders. She managed qualitative research projects to discover, document,
and advocate for best practices in aging in the United States. Currently Jean works
in communications and survey research for Vital Research in Los Angeles,
CA. She obtained her undergraduate degree in business from Lehman College
and holds a master’s degree in aging services management from the University of
Southern California Leonard Davis School of Gerontology.

About the Authors

xvii

Fig. 1.1 Rectangularization of the global aging pyramid from 1970 to
2060 2

Fig. 1.2 Global distribution of population 65 and over in 2015 and
2050. Source: U.S.  Census Bureau, 2013, 2014a, 2014b;
International Data Base, U.S. population estimates, and U.S.
population projections 3

Fig. 1.3 Potential support ratios by region, 2015, 2030, and 2050.
Source: UN Department of Economic and Social Affairs 4

Fig. 3.1 Growth in demand for LTSS. Source: Bipartisan Policy Center 20
Fig. 4.1 Green House at Penfield 36
Fig. 4.2 Penfield Green House Great Room 36
Fig. 4.3 Mr. H’s binder 40
Fig. 4.4 St. John’s to traditional skilled nursing regional comparison 42
Fig. 5.1 Palliative care gap 70
Fig. 8.1 CaringKind entrance welcome 121
Fig. 8.2 MedicAlert® bracelet and necklace 128
Fig. 9.1 Results of HomeMeds PLUS Pilot Program. Source: Partners

in Care Foundation 147
Fig. 10.1 AdvantAge Initiative. Age-friendly Measures 176

List of Figures

1© The Author(s) 2019
J. Galiana, W. A. Haseltine, Aging Well,
https://doi.org/10.1007/978-981-13-2164-1_1

1
Demographics

The commitment of ACCESS Health International to elder care and
optimal aging is fueled by the global change in demographics. The popu-
lation over 60 is expected to double to 22 percent, reaching 2.1 billion
from 2000 to 2050.1 The demographic shift is attributed to increased life
span, lower mortality rates, declining immigration rates, and lower fertil-
ity rates. Figure 1.1 is an example of the rectangularization process from
1970 to 2060.

The 100-year shift that began in 1950 is only 17  years past its mid-
point.2 By 2060, the pyramid will resemble a dome shape. Some predict
that it will morph into the shape of a rectangle3 because, in many coun-
tries, the oldest old (85+) population is growing the fastest.4 The global
population of those 85–99 is projected to increase by 151 percent from
2005 to 2050, while the population of those 100+ is expected to increase
by more than 400 percent5 (Table 1.1).

The demographic shift is occurring at varying rates throughout the
world (Fig. 1.2). The United Nations reported that, in 2015, almost 25
percent of the world’s population 60 and over lived in China and that
only four other countries account for another 25 percent including the

2

United States, Japan, India, and the Russian Federation.6 The projected
growth rate for the over 60 population also varies from country to coun-
try, but is expected to continue to grow globally until 2060.

Potential Support Ratio

One result of the demographic shift is that there will be substantially
more older people who need care and fewer younger people to provide
the care. This care conundrum is reflected in the potential support ratio—
the number of workers (age 15–65) to the number of retirees (65+). The
potential support ratio has been declining substantially from 2000 to
2050 (Fig. 1.3).

With the shrinking potential support ratio, who will care for the grow-
ing number of older adults? Immigration is one answer, but the overarch-
ing response should be that healthcare and social support systems become

Fig. 1.1 Rectangularization of the global aging pyramid from 1970 to 2060

Table 1.1 Projected global population increase by age group 2005–2050

Age Percent increase (%)

0–64 21
65+ 104
85+ 151
100+ 400

Source: National Institute of Aging

J. Galiana and W. A. Haseltine

3

Fig. 1.2 Global distribution of population 65 and over in 2015 and 2050. Source:
U.S. Census Bureau, 2013, 2014a, 2014b; International Data Base, U.S. population
estimates, and U.S. population projections

Demographics

4

more efficient to meet the significant needs of this cohort. Informal
caregivers make invaluable contributions, but they cannot meet the com-
plex care needs of the growing older population. This care gap is further
magnified when considering the rates of comorbidity and cognitive and
functional limitations of the older population.

We will begin with some facts about healthcare in the United States
and then describe solutions to the challenges we have laid out.

Notes

1. World Health Organization (2015). Global strategy and action plan.
2. Bongaarts, J. (2009). Human population growth and the demographic

transition. Philosophical transactions of the Royal Society of London,
364(1532), 2895–2990.

3. (2014). The next America. America’s morphing age pyramid. Pew
Research Center. http://www.pewresearch.org/next-america/age-pyramid/.
Accessed March 2016.

Fig. 1.3 Potential support ratios by region, 2015, 2030, and 2050. Source: UN
Department of Economic and Social Affairs

J. Galiana and W. A. Haseltine

5

4. National Institute on Aging. Why population aging matters: A global per-
spective. Trend 3: rising numbers of the oldest old. https://www.nia.nih.
gov/publication/why-population-aging-matters-global- perspective/trend-
3-rising-numbers-oldest-old. Accessed January 10, 2016.

5. Ibid.
6. United Nations, Department of Economic and Social Affairs, Population

Division (2015). World Population Ageing 2015 (ST/ESA/SER.A/390).

Open Access This chapter is licensed under the terms of the Creative Commons
Attribution 4.0 International License (http://creativecommons.org/licenses/
by/4.0/), which permits use, sharing, adaptation, distribution and reproduction
in any medium or format, as long as you give appropriate credit to the original
author(s) and the source, provide a link to the Creative Commons licence and
indicate if changes were made.

The images or other third party material in this chapter are included in the
chapter’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the chapter’s Creative Commons
licence and your intended use is not permitted by statutory regulation or exceeds
the permitted use, you will need to obtain permission directly from the copy-
right holder.

Demographics

7© The Author(s) 2019
J. Galiana, W. A. Haseltine, Aging Well,
https://doi.org/10.1007/978-981-13-2164-1_2

2
Healthcare in the United States

United States Health Spending and Outcomes

The health spending of the United States is the highest among the OECD
countries. It was 2.5 times greater than the OECD average in 2013.1
Health spending accounted for 16.4 percent of the gross domestic prod-
uct in 20132 and, in 2020, it is projected to represent 20 percent.3 By
2040 it is estimated that one third of all spending in the United States
will be on healthcare.4,5 Despite all of the spending, the health of
Americans lags behind. This is, in large part, a result of America divesting
from prevention and health promotion programs. Another contributing
factor to such poor health outcomes is that the United States does not
invest enough in building robust systems of primary care.6 Although the
United States spends close to the same amount as other Western coun-
tries on healthcare and social supports combined, the United States
spends proportionately less on social services and more on healthcare to
treat people after they become ill7 from what are often preventable dis-
eases. Adults in the United States are more likely than adults in other
developed nations to forgo necessary healthcare because they cannot
afford the cost.8 From 2010 to 2012, 54 percent of people with chronic

8

illness reported that cost was a barrier for them to access care. The patients
surveyed reported that they skipped medications, treatments, and doctor
visits because they could not afford the cost.9 Life expectancy is shorter in
the United States than most OECD countries. As of 2013 life expectancy
in the United States was 78.8, while the OECD average was 80.5.10 In
2014 the Commonwealth Fund ranked the United States healthcare last
among 11 countries.11,12 The measures included access, equity, quality,
efficiency, and healthy lives. Because of these findings, the government
and many health systems in the United States are creating new care mod-
els to address the issues of healthcare access, quality (including patient
satisfaction), and cost. Many of these innovations are designed to serve
older adults because the older cohort interacts with the healthcare system
more than others.

Our ultimate goal, after all, is not a good death, but a good life to the very
end. (Atul Gawande, Being Mortal: Medicine and What Matters in the End)

Optimal Aging

In the United States and internationally, there is a continuing focus on
community supports and inclusive societies that allow older adults to
remain active and engaged. This focus includes age-friendly cities, inclu-
sive housing, and employment opportunities. Most of the improvement
in healthcare and inclusive environments will positively affect those with
dementia, but providers and city planners are also committed to imple-
menting dementia-specific care and support measures.

Geriatric Workforce Shortage

Geriatricians are a critical factor of high-quality care for older adults. The
United States is already struggling with the ability to care for the older
population with the high rates of dementia and other chronic illnesses
and is lacking in a workforce that with appropriate training.13 According
to the American Geriatrics Society, as of 2015, the United States was

J. Galiana and W. A. Haseltine

9

short of 9500 geriatricians.14 This shortage threatens to grow as the popu-
lation ages. The World Health Organization cites that to meet the need
of the growing older population, all healthcare providers must be educated
in gerontology and geriatrics.15 Some suggest that having more geriatri-
cians in the hospital setting could reduce costs.16 This is important
because 25 percent of Medicare spending is attributable to inpatient hos-
pital care.17 Geriatricians are trained to understand and diagnose cogni-
tive problems and functional challenges with activities of daily living.
They also are knowledgeable about how drugs act differently in the aging
body and are adept at polypharmacy management. Additionally, geriatri-
cians are trained to manage multiple comorbidities and understand that
health management is often the primary focus rather than cure.

Prevalence of Chronic Disease

Longevity and lifestyle choices such as smoking, alcohol, and obesity
have contributed to people developing more chronic illnesses. The occur-
rence of multiple chronic conditions increases with age,18 which com-
pounds the burden of caring for the growing aging population. Almost
one half of older adults in America are living with both chronic condi-
tions and functional limitations.19 Eighty percent have at least one
chronic condition, and 50 percent have at least two.20 Approximately 75
percent of Americans 65 and older are living with multiple chronic
conditions21 and 20 percent are living with five or more chronic condi-
tions.22 The oldest old population (80 and older) is growing most rap-
idly23,24 and has the highest rates of comorbidity.

The number of people living with dementia is projected to increase by
more than 200 percent, from 44 million in 2014 to 135 million by 2050.25
One in nine people 65 and older have dementia. The statistics, however,
do not accurately represent the prevalence of dementia because an esti-
mated 50 to 90 percent of dementia cases go undiagnosed.26,27 The global
average rate of undiagnosed cases of dementia is 75 percent.28 The rates of
undiagnosed dementia vary from country to country. The highest rates are
found in the low- and middle-income countries.29 It is nearly impossible
to separate elder care from dementia care after the age of 75 because that

Healthcare in the United States

10

population represents 81 percent of the cases of dementia.30 As we men-
tioned, the oldest old is the population that is growing the fastest. Thirty-
two percent of that cohort have received a diagnosis of dementia.31

It is more expensive to meet the complex care needs of people with
multiple chronic conditions. Many will also need supportive help because
those with multiple chronic conditions experience higher levels of poor
functional status.32,33 Older adults who are living with five or more
chronic illnesses have, on average, 50 prescriptions and 14 different phy-
sicians and make 37 office visits annually.34 Those with multiple chronic
conditions account for 71 percent of the total healthcare spending in the
United States.35 The fee for service individuals with multiple chronic con-
ditions, who are beneficiaries of the government-sponsored Medicare,
accounts for 93 percent of the total Medicare spending.36 The unsustain-
ability of medical costs is an incentive for the Centers for Medicare and
Medicaid to support more efficient, less costly, and better quality systems
of care for the sickest people. The financial burden is also borne by people
living with multiple chronic conditions through out of pocket costs and
the high price of prescription medications.

Meeting the healthcare and social needs of the older population is a world-
wide public health challenge. To properly and sustainably meet the needs of
older adults, providers must challenge fragmented and complex care and
social support systems and implement coordinated, person- centered care
across a variety of care settings and providers. Providers must also foster
chronic disease self-management programs and other forms of patient
engagement. Two important concepts that we address throughout the book
that serve to promote higher-quality accessible care with greater patient satis-
faction at a lower cost are person-centered and value-based care.

Person-Centered Care

One theme that occurs …

Human Behavior and the Social Environment I

Human Behavior and the
Social Environment I

SUSAN TYLER

U N I V E R S I T Y O F A R K A N S A S L I B R A R I E S

F AY E T T E V I L L E , A R

Human Behavior and the Social Environment I by Susan Tyler is licensed under a
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License,
except where otherwise noted.

All content CC BY-NC-SA unless otherwise noted.

Contents

Introduction 1

Attributions 6

Part I. The Person in Environment

Chapter 1: How We Use Our Expectations 25

Part II. The Biopsychosocial Dimension

Chapter 2: Lifespan Theories 79

Part III. The Sociocultural Dimension

Chapter 3: Theoretical Perspectives 105

Chapter 4: The Elements of Culture 120

Part IV. The Social Change Dimension

Chapter 5: Social Categorization & Stereotyping 161

Chapter 6: In-group Favoritism & Prejudice 191

Chapter 7: Reducing Discrimination 210

Chapter 8: Racial & Ethnic Inequality 233

Part V. Pre-Pregnancy & Prenatal Development

Chapter 9: Heredity, Prenatal Development, &

Birth

Heredity 280

Prenatal Development 291

Birth 320

279

Part VI. Development in Infancy & Toddlerhood

Chapter 10: Physical Development in Infancy &

Toddlerhood

347

Chapter 11: Cognitive Development in Infancy &

Toddlerhood

387

Chapter 12: Psychosocial Development in Infancy

& Toddlerhood

Infant Emotions 429

Forming Attachments 433

425

Part VII. Development in Early Childhood

Chapter 13: Physical Development in Early

Childhood

465

Chapter 14: Cognitive Development in Early

Childhood

502

Chapter 15: Psychosocial Development in Early

Childhood

551

Part VIII. Development in Middle Childhood

Chapter 16: Physical Development in Middle

Childhood

603

Chapter 17: Cognitive Development in Middle

Childhood

630

Chapter 18: Psychosocial Development in Middle

Childhood

690

Part IX. Development in Adolescence

Chapter 19: Physical Development in Adolescence 733

Chapter 20: Cognitive Development in

Adolescence

763

Chapter 21: Psychosocial Development in

Adolescence

786

Part X. Development in Early Adulthood

Chapter 22: Physical Development in Early

Adulthood

815

Chapter 23: Cognitive Development in Early

Adulthood

861

Chapter 24: Psychosocial Development in Early

Adulthood

897

Part XI. Development in Middle Adulthood

Chapter 25: Physical Development in Middle

Adulthood

959

Chapter 26: Cognitive Development in Middle

Adulthood

1023

Chapter 27: Psychosocial Development in Middle

Adulthood

1064

Part XII. Development in Late Adulthood

Chapter 28: Physical Development in Late

Adulthood

1135

Chapter 29: Cognitive Development in Late

Adulthood

1197

Chapter 30: Psychosocial Development in Late

Adulthood

1245

Additional Resources 1299

Adopt this book! 1302

Why do people do the things they do?

That’s what we are here to find out – Human Behavior and the
Social Environment (HBSE) – How do they connect? How does it
shape us? Why do we think and feel the way we do?

This will be explored throughout this course by examining human

behavior throughout life stage developments and our interactions

with the social environment. This course will explore theoretical

perspectives in Social Work to help provide a foundation for

organizing thoughts about client needs and issues they are seeking

supports for. Theories will then be connected to important

developmental, social, and cultural issues that present throughout

each stage of life to create an overall picture of a client’s experience

and how we can use this information to have a better understanding

of how people we work with are influenced and why. Knowledge of

typical development in each stage of life will also inform the Social

Worker if any other supports, resources, or services may be needed.

“Social workers are knowledgeable about human

behavior across the life course; the range of social

systems in which people live; and the ways social

systems promote or deter people in maintaining or

achieving health and well-being. Social workers apply

theories and knowledge from the liberal arts to

understand biology, social, cultural, psychological and

spiritual development.” – CSWE (2008, p.6)

There is no single definition for HBSE. I encourage you to think

Introduction | 1

about what it means to you. In Social Work, rarely do we work with

people whose problems are straightforward. Typically we encounter

problems that are complex and interconnected on several levels

and require looking at the relationships between behaviors and

environments. We like to explore as much as possible in Social

Work and use of theories within various dimensions (biological,

psychological, social, and spiritual) allows us to have a broader

knowledge base in several different areas to have a better

understanding and ability to “put it all together” to assess and

intervene with client concerns.

We will utilize vignettes to work in connecting each theory,

approach, perspective, and life stage of development throughout

this course. Each section will begin with a vignette that will be

incorporated throughout to demonstrate examples of each concept

(that is not covered in your readings). Life stage development

vignettes will be used as an “unfolding case” to allow you to work in

critical thinking of how the theories, approaches, and perspectives

connect throughout each life stage.

Social Work Values:

Service – engage in this by helping people address
and hopefully resolve their problems/concerns – also

engage in service through volunteering time to

organizations within the community (boards, mentoring

programs, etc).

Social Justice – advocate and fight against social
injustices for individuals/groups – generally focusing in

areas of poverty, discrimination, education,

unemployment, etc.

2 | Introduction

Integrity – We must always work to be trustworthy,
honest, and responsible in our work and with our

clients.

Competence – always strive to improve our
knowledge and expertise through continuous learning

and education.

Human relationships – connect as partners
throughout the process – also work to improve

relationships within the client’s system to help improve

overall functioning through increased connections/

supports.

Dignity – value and respect each person we meet and
engage with compassion and respect.

Critical Thinking Skills:

What is it?

• Reasoning – interest in the unknown – what’s
going?

• Evaluating – challenging appearances – what do
you think you see vs what you actually see?

• Problem-solving/decision making – explore all
sides and determine the best decision.

Introduction | 3

• Analyzing – how do they connect? What does it
all mean? How does it all add up? Best decision?

Time for reflection.

Why is this important?

1. Theories, approaches, and perspectives help lay the foundation

for any realistic and rational practice in any field. Our

professional values lay the foundation on which social work’s

mission is based. They help guide us in decision making as they

are directed towards a specific purpose and help us to grow

and develop.

2. Justification for your decisions – we must use critical thinking

skills to explore and process how decisions may impact our

clients and we must be able to discuss how our decisions were

determined.

About the Author:

Susan Tyler, MSW, LCSW – Clinical Assistant Professor, University

of Arkansas, Fayetteville, AR

Professor Tyler has been teaching at the School of Social Work

since Spring 2018. Before joining the School of Social Work, she

worked in a community based mental health agency for over 10

years with a focus in Infant and Early Childhood Mental Health

and School-Based Mental Health services revolving around issues

4 | Introduction

related to trauma, abuse, attachment, anxiety, depression, domestic

violence, foster care, adjustments, disruptive behaviors, and ADHD,

through use of play therapy techniques and dyadic interventions.

“Be the change you wish to see in the world” – Mahatma Gandhi
“You can do it” – Rob Schneider

References:

CSWE Commission on Accreditation. (2008). EPAS Handbook.

Council on Social Work Education.

Introduction | 5

Attributions

The Meaning Behind This Book

I began my career in Social Work working in the mental health field

with a focus in Infant and Early Childhood Mental Health. I realized

during this time just how much a person’s experiences and their

environments impacted all aspects of their lives, including why they

made the choices or responded the way they did. After a little over

a decade of mental health work, I had an opportunity to make a

change in my career and joined the world of academia. During my

first semester teaching, I became aware of the Open Educational

Resources at our university and immediately thought of the benefits

of transitioning this course with providing a free, online accessible

textbook that would support both students and instructors alike

in exploring human behavior, social environment, and life stage

development. I began working with the University library system to

compile different chapters from different open and free textbooks

from other disciplines and then added original content to support

connection to Social Work foundations and practice in the first

four sections, as well as creating vignettes to use throughout each

section. This text will support the reader with a deeper

understanding of Social Work theories, perspectives, and

approaches, life stage development, and connection of how they are

utilized in organizing, assessing, and planning for client support.

It is my hope you will come away from this course seeing others

through a lens of empathy, compassion, and curiosity, stopping to

ask yourself, “what must they have experienced in their life?” to

gain a better understanding before jumping to conclusions or

assumptions of others.

“We are all unique. Don’t judge, understand instead.” ~ Roy T.
Bennett

6 | Attributions

Human Behavior and the Social Environment I is adapted from

various work produced and distributed under the Creative

Commons License. Below, is the list of all adapted chapters used in

the making of this book.

Cover Image: Image by Gerd Altmann from Pixabay.
Chapter 1: Adapted from Chapter 2.2 from Principles of Social

Psychology by the University of Minnesota under the Creative

Commons Attribution-NonCommercial-ShareAlike 4.0

International License, except where otherwise noted.

Chapter 2: Adapted from Chapter 9.2: Lifespan Theories
in OpenStax, Psychology. OpenStax CNX. Oct 2, 2019

http://cnx.org/contents/
[email protected] Download for free
at http://cnx.org/contents/
[email protected]

Chapter 3: Adapted from Theoretical Perspectives by Rice
University under the Creative Commons Attribution-

NonCommercial 4.0 license.

Chapter 4: Adapted from Chapter 3.2 from Sociology by the
University of Minnesota under the Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License, except where

otherwise noted.

Chapter 5: Adapted from Chapter 12.1 from Principles of Social
Psychology by the University of Minnesota under the Creative

Commons Attribution-NonCommercial-ShareAlike 4.0

International License, except where otherwise noted.

Chapter 6: Adapted from Chapter 12.2 from Principles of Social
Psychology by the University of Minnesota under the Creative

Commons Attribution-NonCommercial-ShareAlike 4.0

International License, except where otherwise noted.

Chapter 7: Adapted from Chapter 12.3 from Principles of Social
Psychology by the University of Minnesota under the Creative

Commons Attribution-NonCommercial-ShareAlike 4.0

International License, except where otherwise noted.

Chapter 8: Adapted from Chapter 3.1, 3.2, 3.5, 3.6, 3.7, and 3.8

Attributions | 7

from Social Problems by the University of Minnesota under the

Creative Commons Attribution-NonCommercial-ShareAlike 4.0

International License, except where otherwise noted.

Chapter 9: Adapted from Chapter 2 from Lifespan Development:
A Psychological Perspective Second Edition by Martha Lally and

Suzanne Valentine-French under the Creative Commons

Attribution-Noncommercial-Share Alike 3.0 unported license.

Chapter 10 – 12: Adapted from Chapter 3 from Lifespan
Development: A Psychological Perspective Second Edition by

Martha Lally and Suzanne Valentine-French under the Creative

Commons Attribution-Noncommercial-Share Alike 3.0 unported

license.

Chapter 13 – 15: Adapted from Chapter 4 from Lifespan
Development: A Psychological Perspective Second Edition by

Martha Lally and Suzanne Valentine-French under the Creative

Commons Attribution-Noncommercial-Share Alike 3.0 unported

license.

Chapter 16 – 18: Adapted from Chapter 5 from Lifespan
Development: A Psychological Perspective Second Edition by

Martha Lally and Suzanne Valentine-French under the Creative

Commons Attribution-Noncommercial-Share Alike 3.0 unported

license.

Chapter 19 – 21: Adapted from Chapter 6 from Lifespan
Development: A Psychological Perspective Second Edition by

Martha Lally and Suzanne Valentine-French under the Creative

Commons Attribution-Noncommercial-Share Alike 3.0 unported

license.

Chapter 22 – 24: Adapted from Chapter 7 from Lifespan
Development: A Psychological Perspective Second Edition by

Martha Lally and Suzanne Valentine-French under the Creative

Commons Attribution-Noncommercial-Share Alike 3.0 unported

license.

Chapter 25 – 27: Adapted from Chapter 8 from Lifespan
Development: A Psychological Perspective Second Edition by

Martha Lally and Suzanne Valentine-French under the Creative

8 | Attributions

Commons Attribution-Noncommercial-Share Alike 3.0 unported

license.

Chapter 28 – 30: Adapted from Chapter 9 from Lifespan
Development: A Psychological Perspective Second Edition by

Martha Lally and Suzanne Valentine-French under the Creative

Commons Attribution-Noncommercial-Share Alike 3.0 unported

license.

Attributions | 9

PART I

THE PERSON IN
ENVIRONMENT

Learning Objectives:

• Explore the Person in Environment Approach

• Describe the Micro, Mezzo, and Macro

Approach

• Describe the Bio-Psycho-Social-Spiritual

Approach

• Describe Systems Theory

• Describe Ecological Theory

• Describe Ecosystems Theory

• Introduce Strengths Perspective

The Person in Environment | 11

Photo by Christian Erfurt on Unsplash

Vignette

Jason’s parents have been

called by the school social

worker to discuss concerns

related to fighting with a peer

and declining grades. His

parents also report concerns at

home with poor sibling

relationships, anger issues, and

“a bad attitude, always talking

back, never listening or doing

what we ask him to do”. They report a long family history of substance

abuse and mental health issues (anxiety and depression). They report

increased concerns related to this as they recently found marijuana in

Jason’s room. Jason (14 y/o) reports “My parents don’t know what

they’re talking about. My little brother and sister just get me in trouble

because I don’t let them touch my stuff, besides, my parents don’t care,

they don’t listen to me, they just want me to do what they say. And I

don’t see what the big deal is with me smoking a little weed, it helps

me feel better and not be so mad all the time.”

What comes to mind when you hear
Person-In-Environment?

This approach is the concept that people can be heavily influenced

by their environment. It highlights the importance of understanding

an individual and their behavior through their environment. A

person’s environment, along with their experiences, will help shape

the way they view the world, how they think, and why they respond

the way they do. In Social Work, gathering information from our

clients is a foundation piece of the work we do and knowing what

12 | The Person in Environment

information to seek and how to organize it is like gathering pieces

of a puzzle and working to put them together to get the whole

picture (or at least as much of it as we can). This lesson will begin to

introduce some particular approaches, perspectives, and theories

that help build the lens and foundation of the Social Work

profession.

Micro, Mezzo, and Macro

We will first start with the Micro, Mezzo, and Macro Approach. This
is simply looking at levels within a person’s system, which will help

give you some direction in what supports may be needed.

The Micro-level represents individual needs and involves direct
interactions with clients, which is the most common type of social

work. This level explores aspects related to biology, psychological

needs, social (peer) and interpersonal (family) relationships or

supports, and spiritual beliefs.

Jason’s micro level – Biologically no physical health

issues have been reported but some concerns may be

related to how use of marijuana may affect his physical

health. He is an adolescent which means his body

continues to experience hormonal and physical changes.

Family reports history of substance abuse issues as well as

struggles with mental health issues, which may indicate

possible genetic connections to be explored. This may also

be connected to psychological needs as he may be

experiencing anxiety or depressive symptoms or if he

reports use of marijuana as a coping mechanism. He is

The Person in Environment | 13

also reported to present with anger, fighting with his

siblings and struggling with strained family relationships.

This connects us to social aspects, exploring how he

identifies his relationships and supports. No spiritual

beliefs were reported in the vignette but would need to be

explored when meeting with Jason.

The Mezzo-level represents connections or interactions with small
groups, such as family, schools, churches, neighborhoods,

community organizations, and peers/co-workers.

Jason’s mezzo level – Here we would look further into

how his relationships and interactions with various

groups impact him – family, peers, school staff/faculty,

possible spiritual affiliation/church, and any community

groups or organizations he identifies being connected

with.

The Macro-level represents connections to systemic issues within
large systems, such as laws/legislation, policy, healthcare systems,

and international associations. This level also explores ethical

frameworks, historical impacts of group experiences, and how

discrimination and prejudice can impact marginalized populations.

Jason’s macro level – Education/school policies, mental

health policies, healthcare systems, culture and historical

14 | The Person in Environment

impacts of group experiences, drug laws and policies, and

possible discrimination and prejudice impacts need to be

explored.

It is important to remember to explore the interconnectedness and

interactions between what information is presenting on each level

for the person and how this may have an impact on their functioning

and development within their environment.

Bio-Psycho-Social-Spiritual

The Bio-Psycho-Social-Spiritual Approach assesses levels of
functioning within biological, psychological, social, and spiritual

dimensions (and how they are connected) to help understand

human behavior. This approach includes much of the same

information you will find in the Micro level but we are wanting

to take a deeper look at how the individual is functioning in each

dimension as well as how they can impact one another.

The Biological component includes aspects related to overall
health, physical abilities, weight, diet, lifestyle, medication/

substance use, gender, and genetic connections/vulnerabilities.

Jason’s biological aspects – No concerns with overall

physical health, developmental aspects of adolescence

need to be considered, substance use concerns and

impacts, identifies as male, and possible genetic

The Person in Environment | 15

connections/vulnerabilities (substance abuse, anxiety,

depression, or any other family history of concern).

The Psychological component includes aspects related to mental
health, self-esteem, attitudes/beliefs, temperament, coping skills,

emotions, learning, memory, perceptions, and personality.

Jason’s psychological aspects – Anger, substance use

concerns and impacts, possible esteem issues, poor coping

skills and emotional regulation, cognitive development

and any related concerns, personality and temperament

characteristics, and explorations of how he perceives his

world.

The Social component includes aspects related to peer and family
relationships, social supports, cultural traditions, education,

employment/job security, socioeconomic status, and societal

messages.

Jason’s social aspects – Strained family relationships,

school relationships/educational supports, exploration of

socioeconomic impacts, exploration of cultural traditions,

16 | The Person in Environment

and identification/exploration of peer relationships and

supports.

The Spiritual component includes aspects related to spiritual or
religious beliefs, or belief in a “higher being” or higher power they

feel connected to or supported by.

Jason’s spiritual aspects – No spiritual aspects were

reported but we would want to explore what this means

to Jason. Does he identify with a church, religion, or

higher power/being? What does it mean to him? Does it

bring any support and comfort or is it causing increased

stress as he is working to “figure out what it all means”?

Looking at each dimension of the Bio-Psycho-Social-Spiritual

Approach allows you to engage in a more holistic exploration and

assessment of a person as it examines and connects four important

domains of their life.

Systems Theory

Systems Theory states behavior is influenced by a result of factors
that work together as a system and are interconnected – each part

plays an important role in the function of the whole, and the whole

in turn supports and sustains the parts. A person’s family, friends,

school, work, economic class, home environment, and other factors

all influence how a person thinks and acts. A social worker must

The Person in Environment | 17

observe and assess all of the systems a person experiences, as they

contribute to their behavior and well-being, and work to strengthen

those systems as they are connected and influence one another.

This is used to develop a holistic view of individuals within their

environment, which is then used to lead to the most appropriate

practice intervention.

Within Systems Theory we will also explore roles (routine tasks

and behaviors of people within a system). We all have roles and

engage in them whether we recognize it or not. Some examples of

roles are leader, caretaker, parent, child, sibling, enabler, scapegoat,

citizen, spouse, and worker. Many people feel their roles identify

them. This may reinforce behaviors when positive feelings or

experiences are associated with the role(s) or maybe a motivator for

change when the role(s) are connected to more negative feelings or

experiences. Knowing what roles a person is engaged in, and how

they perceive each role, will support your work in understanding

their experiences and what needs are presenting.

Ecological Theory

Ecological Theory focuses on the interaction between the
individual and their environment. It discusses the active

involvement of people with their environments and development as

well as both (environment/development) continuously changing.

“Thoughts become perception, Perception becomes reality. Alter
your thoughts, Alter your reality.” ~ William James

An important reminder of this theory is to remember the

importance of perception – how people perceive or interpret their

environment and experiences influences their overall functioning

or well-being. This is also regardless of how problems or concerns

may appear to the social worker. You will need to explore how the

client views their situation before assuming certain situations are

problematic. We need to try and see it through their eyes and get

18 | The Person in Environment

an understanding of how they were feeling. It is their story and

their reality. In social work practice, this can best be understood by

looking at individuals, families, policies, communities, and cultures

and identifying strengths and weaknesses in the transactional

processes between the systems.

Bronfenbrenner’s Ecological Systems Model used to
explore Ecosystems Theory:

https://www.slideshare.net/CLMontecarlo/

bronfenbrenner-ecological-theory-54149823

Bronfenbrenner believed an individual’s development was affected

by everything in their surrounding environment and divided the

environment into five different levels: the microsystem, the

mesosystem, the exosystem, the macrosystem, and the

chronosystem.

The microsystem is the system closest to the individual and the
one in which they have direct interactions. Some examples include

home, school, or work. A microsystem typically includes family,

peers, or caregivers. Relationships in a microsystem are bi-

directional, meaning, how you respond and react to the people will

affect their response and reaction to you. This is the most influential

level within the theory.

The mesosystem is where a person’s individual microsystems are
interconnected and influence one another. These interactions have

an indirect impact on the individual, which can be positive or

negative depending on the elements of the system working together

(positive) or working against each other (negative).

The exosystem refers to a setting in which the person is not
an active participant, but still affects them. This includes decisions

The Person in Environment | 19

that affect a person, but they have no decision-making abilities. An

example of this would be a child affected by a parent losing a job.

The macrosystem is the cultural environment in which the
person lives and all other systems that affect them such as economy,

cultural values, and political systems.

The chronosystem encompasses transitions and shifts
throughout a person’s life. It looks at the timing of the event in

relation to a person’s development, such as how death affects

children of different ages. Historical events that occur during a

person’s life are also explored such as the impacts of the September

11th attacks.

Jason’s story – With use of Systems Theory, we will

want to look at aspects of micro, mezzo, and macro levels

as well as bio-psycho-social-spiritual dimensions above

and how they interact and influence one another. Here we

will also explore what roles Jason feels he engages in (son,

brother, student, friend) as well as roles he may not

recognize or identify (leader, caretaker (if he is asked to

help with caring for younger siblings), or role model). We

will also want to explore how Jason perceives each role

(positive or negative) to gain a better understanding of his

experience and work in supporting his needs. With use of

Ecological Theory, we add the addition of looking at how

development and environment continue to grow and

change, and how this continues to impact our clients as

they engage within their systems. Ecosystems Theory

takes from both Systems Theory and Ecological Theory,

combining major tenets from each and providing us the

opportunity to look deeper into the complexity of each

network a client experiences and gain a better

20 | The Person in Environment

understanding of how they interact and impact one

another.

Strengths Perspective

A foundational perspective of Social Work is the Strengths
Perspective. All people have strengths and abilities that allow them
to grow and adapt. This perspective takes the focus off the problem

and allows us to identify ways for clients to use their strengths

in achieving their goals. Clients are seen as the experts of their

experiences. We utilize their insights to explore times of resiliency

and partner with them to identify supports and solutions and help

support their ability to grow. It is also important to remember to

evaluate the environment for possible barriers and impacts while

assessing needs and strengths.

The Person in Environment | 21

A YouTube element has been excluded from this version of the

text. You can view it online here: https://uark.pressbooks.pub/

hbse1/?p=3

Jason’s Strengths – Family support, both biological

parents in home and still together, awareness of family

history, school supports, able bodied, no developmental

delays reported (but should be explored if any concerns

connected to this), has found a coping skills (even if it is

not the most appropriate way, he is engaging in some self

regulation work), and was able to engage with the school

Social Worker during their meeting instead of remaining

closed off and refusing to speak.

22 | The Person in Environment

What other strengths can you identify?

How would you work to explore and …

Human Behavior and the Social Environment II

Human Behavior and the
Social Environment II

WHITNEY PAYNE

U N I V E R S I T Y O F A R K A N S A S L I B R A R I E S

F AY E T T E V I L L E , A R

Human Behavior and the Social Environment II by Whitney Payne is licensed under a
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License,
except where otherwise noted.

Content in his book is adapted was from

• Kennedy, Vera. (2018). Beyond race: cultural influences on

human social life. This work is licensed under a Creative

Commons Attribution-NonCommercial-ShareAlike 4.0

International License

• “Beyond Race: Cultural Influences on Human Social Life” by

Vera Kennedy under the license CC BY-NC-SA 4.0.

• Social Problems by University of Minnesota is licensed under

a Creative Commons Attribution-NonCommercial-ShareAlike

4.0 International License, except where otherwise noted.

• Introduction to Women, Gender, Sexuality Studies by Miliann

Kang, Donovan Lessard, Laura Heston, Sonny Nordmarken is

licensed under a Creative Commons Attribution 4.0

International License,

• Principles of Social Psychology by University of Minnesota

under the Creative Commons Attribution-NonCommercial-

ShareAlike 4.0 International License,

• McAdams, D. P. (2019). Self and identity. In R. Biswas-Diener &

E. Diener (Eds), Noba textbook series: Psychology. Champaign,

IL: DEF publishers. Retrieved from http://noba.to/3gsuardw.

Self and Identity by Dan P. McAdams is licensed under

a Creative Commons Attribution-NonCommercial-ShareAlike

4.0 International License.

• Immigrant and Refugee Families, 2nd Ed. by Jaime Ballard,

Elizabeth Wieling, Catherine Solheim, and Lekie Dwanyen is

licensed under a Creative Commons Attribution-

NonCommercial 4.0 International License, except where

otherwise noted.

Contents

Introduction 1

Attributions 4

Part I. Traditional Paradigms & Dominant

Perspectives on Individuals

Chapter 1: Self and Identity

1.1 Introduction 14

1.2 The Social Actor 15

1.3 The Motivated Agent 19

1.4 The Autobiographical Author 21

1.5 End-of-Chapter Summary 26

1.6 Outside Resources 27

1.7 Discussion Questions 27

13

Chapter 2: Culture and Meaning

2.1 Introduction 33

2.2 Link between Culture and Society 34

2.3 Defining Culture 35

2.4 Cultural Sociology 39

2.5 Theoretical Perspectives on Culture 42

33

Chapter 3: Culture as a Social Construct

3.1 Social Production of Culture 53

3.2 Collective Culture 56

3.3 Cultural Change 69

53

Chapter 4: Cultural Power

4.1 Cultural Hierarchies 72

4.2 Cultural Hegemony 79

4.3 Prejudice and Discrimination 82

72

Chapter 5: Cultural Identity

5.1 Identity Formation 90

5.2 Sex and Gender 94

5.3 Sexuality and Sexual Orientation 99

5.4 Body and Mind 103

5.5 Race and Ethnicity 108

5.6 Religion and Belief Systems 114

5.7 Identity Today 120

90

Chapter 6: The Multicultural World

6.1 Globalization and Identity 133

6.2 Building Cultural Intelligence 138

133

Part II. Alternative Perspectives on Individuals

Chapter 7: Individual and Cultural Differences in

Person Perception

7.1 Introduction 151

7.2 Perceiver Characteristics 152

7.3 Cultural Differences in Person Perception 156

7.4 Attribution Styles and Mental Health 160

7.5 End-of-Chapter Summary 164

151

Chapter 8: Poverty

8.1 Introduction 170

8.2 The Measurement & Extent of Poverty 174

8.3 Who the Poor Are: Social Patterns of Poverty 181

8.4 Explaining Poverty 195

8.5 The Consequences of Poverty 210

8.6 Global Poverty 224

8.7 Reducing Poverty 246

8.8 End-of-Chapter Summary 256

170

Chapter 9: People of Color, White Identity, &

Women

9.1 Introduction to Prejudice, Discrimination, and

Stereotyping

260

9.2 Dimension of Racial and Ethnic Equality 276

9.3 Feminism and Sexism 286

9.4 Reducing Gender Inequality 292

9.5 The Benefits and Costs of Being Male 296

9.6 Masculinities 300

260

Chapter 10: Aging and Ableness

10.1 Aging Social Problems in the News 303

10.2 Age Cohorts 304

10.3 The Concept & Experience of Aging 307

10.4 Perspectives on Aging 309

10.5 Life Expectancy & the Graying of Society 313

10. 6 Biological & Psychological Aspects of Aging 317

10.7 Children and Our Future 319

10.8 Applying Social Research 321

10.9 Problems Facing Older Americans 324

10.10 Lessons from Other Societies 332

10.11 People Making a Difference 340

10.12 Reducing Ageism & Helping Older Americans 344

10.13 End-of-Chapter Summary 348

302

Chapter 11: Sexual Orientation, Sexuality, &

Pornography

11.1 What is Sex, Gender, Sexuality, & Sexual

Orientation?

351

11.2 Sexual Orientation and Inequality 356

11.3 Understanding Sexual Orientation 359

11.4 Public Attitudes About Sexual Orientation 377

11.5 Inequality Based on Sexual Orientation 392

11.6 Improving the Lives of the LGBT Community 419

11.7 Sexual Orientation & Inequality Summary 422

11.8 Pornography 425

351

Part III. Perspectives on Families

Chapter 12: The Family

12.1 Introduction 439

12.2 What is Family? 440

12.3 How Families Develop 444

12.4 Dating, Courtship, and Cohabitation 447

12.5 Family Issues and Considerations 456

12.6 Happy Healthy Families 461

12.7 Additional Resources 462

439

Chapter 13: Relationships & Well-Being

13.1 Introduction 468

13.2 The Importance of Relationships 469

13.3 The Question of Measurement 470

13.4 Presence and Quality of Relationships and

Well-Being

474

13.5 Types of Relationships 479

13.6 Fact or Myth: Are Social Relationships the

Secret to Happiness?

483

13.7 Additional Resources 485

468

Chapter 14: Childhood Experiences & Epigenetics

14.1 Early childhood experience 491

14.2 Parental investment and programming of stress

responses in the offspring

492

14.3 Child nutrition and the epigenome 495

491

Part IV. Perspectives on Groups

Chapter 15: Working Groups: Performance &

Decision Making

15.1 Introduction 505

15.2 Understanding Social Groups 510

15.3 Group Process: the Pluses & Minuses of

Working Together

521

15.4 Improving Group Performance 573

15.5 Thinking Like A Social Psychologist About

Social Groups

590

15.6 End-of-Chapter Summary 592

503

Chapter 16: The Psychology of Groups

16.1 Introduction to the Psychology of Groups 597

16.2 The Psychological Significance of Groups 599

16.3 Motivation and Performance 604

16.4 Making Decisions in Groups 613

16.5 You and Your Groups 619

16.6 Outside Resources 620

16.7 References 622

596

Part V. Stages of Group Development & Group

Think

Chapter 17: Groupthink

17.1 Overview of Groupthink 632

17.2 Additional Resources 634

631

Part VI. Perspectives on Organizations

Chapter 18: Industrial/Organizational Psychology

19.1 What is Industrial and Organizational (I/O)

Psychology?

640

19.2 What Does an I/O Psychologist Do? 644

19.3 Careers in I/O Psychology 647

19.4 History of I/O Psychology 649

19.5 Additional Resources 653

639

Chapter 19: Competition and Cooperation in Our

Social Worlds

19.1 Competition and Cooperation in Our Social

Worlds

657

19.2 Conflict, Cooperation, Morality, and Fairness 662

19.3 How the Social Situation Creates Conflict: The

Role of Social Dilemmas

684

19.4 Strategies for Producing Cooperation 704

19.5 Thinking Like a Social Psychologist About

Cooperation and Competition

721

19.6 End-of-Chapter Summary 722

657

Chapter 20: Group & Organizational Culture

20.1 Introduction 726

20.2 Group Dynamics 727

20.3 Organization 729

20.4 Symbolic Power 730

20.5 Organizational Culture 730

726

Part VII. Perspectives on Communities

Chapter 21: Geographic Region

21.1 Communities Based Upon Geographical Region 738

737

Chapter 22: Population & the Environment

22.1 Introduction 743

22.2 Sociological Perspectives on Population & the

Environment

744

22.3 Population 750

23.4 The Environment 785

22.5 Addressing Population Problems & Improving

the Environment

820

22.6 End-of-Chapter Summary 825

742

Chapter 23: Urban & Rural Problems

23.1 Introduction 829

23.2 A Brief History of Urbanization 831

23.3 Sociological Perspectives on Urbanization 843

23.4 Problems of Urban Life 853

23.5 Problems of Rural Life 880

23.6 Improving Urban & Rural Life 888

23.7 End-of-Chapter Summary 890

829

Part VIII. Communities & Police Relations

Chapter 24: The Criminal Justice System

24.1 Introduction 897

24.2 Police 898

24.3 Criminal Courts 901

24.4 The Problem of Prisons 903

24.5 Focus on the Death Penalty 907

897

Part IX. Global Perspectives & Theories

Chapter 25: Immigration & Immigrant Policy:

Barriers & Opportunities for Families

25.1 Introduction 918

25.2 Immigration Policy 921

25.3 Current Immigration Policy 929

25.4 Opportunities & Barriers for Immigrant

Families

935

25.5 Future Directions 944

25.6 End-of-Chapter Summary 946

27.7 Appendices 956

917

Chapter 26: From There to Here: The Journey of

Refugee Families to the United States

26.1 Introduction 965

26.2 Fleeing Persecution and Separation from

Family

966

26.3 Travel to Temporary Refuge 969

26.4 Family Admittance to the United States 971

26.5 Entering the United States 974

26.6 Future Directions in Policy and Refugee Family

Support

986

26.7 Conclusion 988

26.8 Appendix 995

964

Chapter 27: Human Rights

27.1 Introduction 999

27.2 What are Human Rights? 1001

27.3 The Universal Declaration of Human Rights 1004

27.4 The Status of Human Rights in the United

States

1006

27.5 Emerging Directions 1021

27.6 End-of-Chapter Summary 1023

998

Chapter 28: Economic Well-Being, Supports &

Barriers

28.1 Introduction 1031

28.2 Employment 1033

28.3 Access to Necessities 1040

28.4 Financial Problems 1052

28.5 Future Directions 1057

28.6 End-of-Chapter Summary 1059

1030

Chapter 29: Mental Health

29.1 Introduction 1070

29.2 Different Shared Experiences 1072

29.3 Mental Health Challenges 1075

29.4 Mental Health Treatments 1086

29.5 Emerging Directions 1092

29.6 End-of-Chapter Summary 1094

1070

Chapter 30: Intimate Partner Violence Among

Immigrants & Refugees

32.1 Introduction 1109

32.2 Defining IPV 1112

32.3 IPV Among Immigrants & Refugees 1115

32.4 Risk & Protective Factors 1116

32.5 Responses to IPV 1119

32.6 Barriers to Help Seeking 1123

32.7 Future Decisions 1134

32.8 Case Study 1135

32.9 End-of-Chapter Summary 1136

1108

Chapter 31: Substance Abuse

33.1 Introduction 1148

33.2 Substance Abuse Prevalence 1151

33.3 Risk Factors 1154

33.4 Family Influences on Substance Abuse 1159

33.5 Theoretical Frameworks 1160

33.6 Policy on Legal Consequences on Substance

Abuse

1165

33.7 Substance Abuse Prevention & Intervention 1166

33.8 End-of-Chapter Summary 1171

1148

Chapter 32: Resilience in Immigrant & Refugee

Families

34.1 Introduction 1185

34.2 Family Motivation: Value of Work & Education 1186

34.3 Family Connectedness & Identity 1194

34.4 Role of Resources in Achieving Aspirations 1202

34.5 Emerging Directions 1208

34.6 End-of-Chapter Summary 1210

1184

Chapter 33: Embracing a New Home:

Resettlement Research & the Family

35.1 Introduction 1222

35.2 Assimilation 1222

35.3 Family Theories: A New Direction for Research

with Resettled Populations

1235

35.4 Critical Theories 1241

35.5 Cultural Values to Consider in Resettlement

Research

1241

35.6 Future Directions 1245

35.7 End-of-Chapter 1246

1221

Part X. Additional Resources

Introduction

The Meaning Behind This Book

In the Fall of 2003, I started my undergraduate career at the

University of Alaska Anchorage. For as long as I could remember I

had wanted to be a veterinarian and had begun my freshman year

as a Pre-vet major. Before long, I came to the startling realization

that biology and chemistry were not a place of academic strength

for me and my hopes of making it through four more years of these

particular types of classes became daunting and perhaps unrealistic.

However, at this same time, I was enrolled in an Introduction to

Social Work and Social Welfare Policy course, and it had become a

respite from the periodic table of elements and algebraic algorithms

that were the cornerstone of my other classes that semester. Before

enrolling in that course, I had no idea that a profession such as

Social Work existed. I had spent most of my life interested in human

behavior and how the environment can influence the way that

people navigate their lives. I had also been enamored by social

justice movements and had started to really recognize how policy

decisions can have collateral consequences on individuals, groups,

and communities. Needless to say, the Introduction to Social Work

course changed the trajectory of my personal and professional life,

and I went on to earn my BSW as well as my MSW.

After I completed graduate school, I began working as a substance

abuse counselor within the prison system in Arkansas, and during

my time there it became even more clear to me how much

individuals are shaped by their environments. An overwhelming

majority of the clients that I worked with had been survivors of

trauma and had been at the mercy of generational cycles of poverty,

abuse, addiction, and criminal justice involvement. These were not

individuals that were making random, bad choices. These were

Introduction | 1

individuals who were facing extreme structural impediments in life

and who were doing the best that they could with the resources

and skills that they had at the time. And, just like that, I finally

understood how multidimensional the treatment needs of

individuals can be and how every person’s story and potential

success is based on our ability, as the clinician, to attend to and

acknowledge the complexity of their lives.

After several years of clinical practice, I made the unexpected

transition to academia and was given the opportunity to teach the

Human Behavior and the Social Environment course. After working

on the curriculum for two semesters, it became clear to me that

students wanted and desired a textbook that was free, easy to

access online, and contained information from a multitude of

disciplines. I was fortunate enough to learn about Open Educational

Resources at our institution and began working with the University

library system to compile several different chapters from several

different open and free textbooks. These materials will help

students and instructors alike explore human behavior and how

it is shaped and impacted by both traditional and non-traditional

paradigms. This text will also support the reader in having a deeper

understanding of how the environment, in all of its complexity, can

affect individuals, families, groups, and communities.

It is my hope that the information contained in this book will

help you, as a future social worker, approach client systems with

empathy, understanding, and a compassionate curiosity that allows

for comprehensive assessment, individualized approaches to

treatment, and continuity of care.

“Social advance depends as much upon the process through which
it is secured as upon the result itself.” –Jane Addams

2 | Introduction

About the Author:

Professor Whitney Payne was the Treatment Coordinator of the

Northwest Arkansas Community Correction Center, a residential

treatment facility that serves 100 non-violent, female offenders who

often struggle with chemical dependency. Professor Payne worked

at NWACCC from June of 2010 August of 2016. Professor Payne

became an adjunct faculty member with the University of Arkansas

School of Social Work in August of 2012 and was hired as a Clinical

Assistant Professor in August of 2016. Professor Payne graduated

with a BSW from the University of Alaska Anchorage in 2008 and

an MSW for the University of Arkansas in 2010. In addition to these

degrees, Professor Payne is a Licensed Clinical Social Worker as well

as a Certified Drug and Alcohol Counselor.

Introduction | 3

Attributions

Human Behavior and the Social Environment II is adapted from

various work produced and distributed under the Creative

Commons License. Below, is the list of all adapted chapters used in

the making of this book.

COVER DESIGN: Image by Gerd Altmann from Pixabay.

CHAPTER 1: Adapted from Self and Identity by Dan P. McAdams
under the Creative Commons Attribution-NonCommercial-

ShareAlike 4.0 International License.

CHAPTER 2: Adapted from Module 1 from “Beyond Race: Cultural
Influences on Human Social Life” by Vera Kennedy under the license

CC BY-NC-SA 4.0.

CHAPTER 3: Adapted from Module 2 from “Beyond Race: Cultural
Influences on Human Social Life” by Vera Kennedy under the license

CC BY-NC-SA 4.0.

CHAPTER 4: Adapted from Module 3 from “Beyond Race: Cultural
Influences on Human Social Life” by Vera Kennedy under the license

CC BY-NC-SA 4.0.

CHAPTER 5: Adapted from Module 4 from “Beyond Race: Cultural
Influences on Human Social Life” by Vera Kennedy under the license

CC BY-NC-SA 4.0.

CHAPTER 6: Adapted from Module 5 from “Beyond Race: Cultural
Influences on Human Social Life” by Vera Kennedy under the license

CC BY-NC-SA 4.0.

CHAPTER 7: Adapted from Chapter 6.3 from Principles of Social
Psychology by the University of Minnesota under the Creative

4 | Attributions

Commons Attribution-NonCommercial-ShareAlike 4.0

International License.

CHAPTER 8: Adapted from Chapter 2 from Social Problems by the
University of Minnesota under the Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License, except where

otherwise noted.

CHAPTER 9: Adapted from Prejudice, Discrimination, and
Stereotyping by Susan T. Fiske under the Creative Commons

Attribution-NonCommercial-ShareAlike 4.0 International License.

Adapted from Chapter 3.2, Social Problems by University of

Minnesota is licensed under a Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License, except where

otherwise noted.

Adapted from Chapter 4.2, Social Problems by University of

Minnesota is licensed under a Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License, except where

otherwise noted.

Adapted from Chapter 4.6, Social Problems by University of

Minnesota is licensed under a Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License, except where

otherwise noted.

Adapted from Chapter 4.5, Social Problems by University of

Minnesota is licensed under a Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License, except where

otherwise noted.

Adapted from Unit II, Introduction to Women, Gender, Sexuality

Studies by Miliann Kang, Donovan Lessard, Laura Heston, Sonny

Nordmarken is licensed under a Creative Commons Attribution 4.0

International License, except where otherwise noted.

CHAPTER 10: Adapted from Chapter 6 from Social Problems by the
University of Minnesota under the Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License, except where

otherwise noted.

Attributions | 5

Adapted from page 37 through 38, Self and Identity by Dan P.

McAdams under the Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License.

CHAPTER 11: Adapted from Chapter 5 and Chapter 9.5 from Social
Problems by University of Minnesota under the Creative Commons

Attribution-NonCommercial-ShareAlike 4.0 International License,

except where otherwise noted.

Adapted from pages 39 through 43 from “Beyond Race: Cultural

Influences on Human Social Life” by Vera Kennedy under the license

CC BY-NC-SA 4.0.

Adapted from The International Encyclopedia of Human Sexuality.

CHAPTER 12: Adapted from The Family by Joel A. Muraco is licensed
under a Creative Commons Attribution-NonCommercial-

ShareAlike 4.0 International License.

CHAPTER 13: Adapted from Relationships and Well-
being by Kenneth Tan and Louis Tay is licensed under a Creative

Commons Attribution-NonCommercial-ShareAlike 4.0

International License.

CHAPTER 14: Adapted from Epigenetics in Psychology by Ian
Weaver under the CC BY-NC-SA: Attribution-NonCommercial-

ShareAlike license.

CHAPTER 15: Adapted from Chapter 11 from Principles of Social
Psychology by University of Minnesota under the Creative

Commons Attribution-NonCommercial-ShareAlike 4.0

International License, except where otherwise noted.

CHAPTERS 16 & 17: Adapted from The Psychology of
Groups by Donelson R. Forsyth under the Creative Commons

Attribution-NonCommercial-ShareAlike 4.0 International License.

CHAPTER 18: Adapted from Industrial/Organizational (I/O)
Psychology by Berrin Erdogan and Talya N. Bauer under the

6 | Attributions

Creative Commons Attribution-NonCommercial-ShareAlike 4.0

International License.

CHAPTER 19: Adapted from Chapter 13 from Principles of Social
Psychology by University of Minnesota under the Creative

Commons Attribution-NonCommercial-ShareAlike 4.0

International License, except where otherwise noted.

CHAPTER 20: Adapted from pages 17 through 20 from “Beyond
Race: Cultural Influences on Human Social Life” by Vera Kennedy

under the license CC BY-NC-SA 4.0.

CHAPTER 21: Adapted from pages 43 through 44 from “Beyond
Race: Cultural Influences on Human Social Life” by Vera Kennedy

under the license CC BY-NC-SA 4.0.

CHAPTER 22: Adapted from Chapter 15 from Social Problems by the
University of Minnesota under the Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License, except where

otherwise noted.

CHAPTER 23: Adapted from Chapter 14 from Social Problems by the
University of Minnesota under the Creative Commons Attribution-

NonCommercial-ShareAlike 4.0 International License, except where

otherwise noted.

CHAPTER 24: Adapted from Chapter 8.5 from Social Problems by
the University of Minnesota under the Creative Commons

Attribution-NonCommercial-ShareAlike 4.0 International License,

except where otherwise noted.

CHAPTER 25: Adapted from Chapters 1 from Immigrant and Refugee
Families, 2nd Ed. by Jaime Ballard, Elizabeth Wieling, Catherine

Solheim, and Lekie Dwanyen under the Creative Commons

Attribution-NonCommercial 4.0 International License, except

where otherwise noted.

CHAPTER 26: Adapted from Chapters 2 from Immigrant and

Attributions | 7

Refugee Families, 2nd Ed. by Jaime Ballard, Elizabeth Wieling,

Catherine Solheim, and Lekie Dwanyen under the Creative

Commons Attribution-NonCommercial 4.0 International License,

except where otherwise noted.

CHAPTER 27: Adapted from Chapters 3 from Immigrant and
Refugee Families, 2nd Ed. by Jaime Ballard, Elizabeth Wieling,

Catherine Solheim, and Lekie Dwanyen under the Creative

Commons Attribution-NonCommercial 4.0 International License,

except where otherwise noted.

CHAPTER 28: Adapted from Chapters 4 from Immigrant and
Refugee Families, 2nd Ed. by Jaime Ballard, Elizabeth Wieling,

Catherine Solheim, and Lekie Dwanyen under the Creative

Commons Attribution-NonCommercial 4.0 International License,

except where otherwise noted.

CHAPTER 29: Adapted from Chapters 5 from Immigrant and
Refugee Families, 2nd Ed. by Jaime Ballard, Elizabeth Wieling,

Catherine Solheim, and Lekie Dwanyen under the Creative

Commons Attribution-NonCommercial 4.0 International License,

except where otherwise noted.

CHAPTER 30: Adapted from Chapters 6 from Immigrant and
Refugee Families, 2nd Ed. by Jaime Ballard, Elizabeth Wieling,

Catherine Solheim, and Lekie Dwanyen under the Creative

Commons Attribution-NonCommercial 4.0 International License,

except where otherwise noted.

CHAPTER 31: Adapted from Chapters 7 from Immigrant and Refugee
Families, 2nd Ed. by Jaime Ballard, Elizabeth Wieling, Catherine

Solheim, and Lekie Dwanyen under the Creative Commons

Attribution-NonCommercial 4.0 International License, except

where otherwise noted.

CHAPTER 32: Adapted from Chapters 8 from Immigrant and
Refugee Families, 2nd Ed. by Jaime Ballard, Elizabeth Wieling,

8 | Attributions

Catherine Solheim, and Lekie Dwanyen under the Creative

Commons Attribution-NonCommercial 4.0 International License,

except where otherwise noted.

CHAPTER 33: Adapted from Chapters 9 from Immigrant and
Refugee Families, 2nd Ed. by Jaime Ballard, Elizabeth Wieling,

Catherine Solheim, and Lekie Dwanyen under the Creative

Commons Attribution-NonCommercial 4.0 International License,

except where otherwise noted.

Attributions | 9

PART I

TRADITIONAL
PARADIGMS & DOMINANT
PERSPECTIVES ON
INDIVIDUALS

Traditional Paradigms & Dominant
Perspectives on Individuals | 11

Chapter 1: Self and Identity

Learning Objectives

• Explain the basic idea of reflexivity in human

selfhood—how the “I” encounters and makes sense of

itself (the “Me”).

• Describe fundamental distinctions between three

different perspectives on the self: the self as actor,

agent, and author.

• Describe how a sense of self as a social actor

emerges around the age of 2 years and how it

develops going forward.

• Describe the development of the self’s sense of

motivated agency from the emergence of the child’s

theory of mind to the articulation of life goals and

values in adolescence and beyond.

• Define the term narrative identity, and explain what

psychological and cultural functions narrative

identity serves.

For human beings, the self is what happens when “I” encounters

“Me.” The central psychological question of selfhood, then, is this:

How does a person apprehend and understand who he or she is?

Self and Identity | 13

Over the past 100 years, psychologists have approached the study

of self (and the related concept of identity) in many different ways,

but three central metaphors for the self repeatedly emerge. First,

the self may be seen as a social actor, who enacts roles and displays

traits by performing behaviors in the presence of others. Second,

the self is a motivated agent, who acts upon inner desires and

formulates goals, values, and plans to guide behavior in the future.

Third, the self eventually becomes an autobiographical author, too,

who takes stock of life — past, present, and future — to create a story

about who I am, how I came to be, and where my life may be going.

This module briefly reviews central ideas and research findings on

the self as an actor, an agent, and an author, with an emphasis on

how these features of selfhood develop over the human life course.

1.1 Introduction

In the Temple of Apollo at Delphi, the ancient Greeks inscribed the

words: “Know thyself.” For at least 2,500 years, and probably longer,

human beings have pondered the meaning of the ancient aphorism.

Over the past century, psychological scientists have joined the

effort. They have formulated many theories and tested countless

hypotheses that speak to the central question of human selfhood:

How does a person know who he or she is?

The ancient Greeks seemed to realize that the self is inherently

reflexive—it reflects back on itself. In the disarmingly simple idea

made famous by the great psychologist William James (1892/1963),

the self is what happens when “I” reflects back upon “Me.” The self

is both the I and the Me—it is the knower, and it is what the knower

knows when the knower reflects upon itself. When you look back

at yourself, what do you see? When you look inside, what do you

find? Moreover, when you try to change your self in some way, what

is it that you are trying to change? The philosopher Charles Taylor

(1989) describes the self as a reflexive project. In modern life, Taylor

14 | Self and Identity

argues that, we often try to manage, discipline, refine, improve, or

develop the self. We work on our selves, as we might work on any

other interesting project. But what exactly is it that we work on?

Imagine for a moment that you have decided to improve yourself.

You might say, go on a diet to improve your appearance. Or you

might decide to be nicer to your mother, in order to improve that

important social role. Or maybe the problem is at work—you need

to find a better job or go back to school to prepare for a different

career. Perhaps you just need to work harder. Or get organized. Or

recommit yourself to religion. Or maybe the key is to begin thinking

about your whole life story in a completely different way, in a way

that you hope will bring you more happiness, fulfillment, peace, or

excitement.

Although there are many different ways you might reflect upon

and try to improve the self, it turns out that many, if not most,

of them fall roughly into three broad psychological categories

(McAdams & Cox, 2010). The I may encounter the Me as (a) a social

actor, (b) a motivated agent, or (c) an autobiographical author.

1.2 The Social Actor

Shakespeare tapped into a deep truth about human nature when

he famously wrote, “All the world’s a stage, and all the men and

women merely players.” He was wrong about the “merely,” however,

for there is nothing more important for human adaptation than the

manner in which we perform our roles as actors in the everyday

theatre of social life. What Shakespeare may have sensed but could

not have fully understood is that human beings evolved to live in

social groups. Beginning with Darwin (1872/1965) and running

through contemporary conceptions of human evolution, scientists

have portrayed human nature as profoundly social (Wilson, 2012).

For a few million …