Fathering on Tenuous Ground, A Qualitative Meta-Synthesis on Teen Fathering
Background: Although teen fathers are a vulnerable group of parents, they have received far less attention than teen mothers. Purpose: We conducted a systematic search of qualitative studies that examined their prenatal and postpartum experience to better understand teen fathers’ concerns, strengths, and vulnerabilities. Methods: We searched nine electronic databases through September 2017; 29 studies represented in 30 articles met study criteria. All authors independently extracted data from each article. Coding decisions were reviewed weekly and differences were settled by consensus. Results: From pooling the results of 29 primary studies, we describe how a tenuous ground contributes to teen paternity and imperils young fathers’ involvement with their children. In the best of circumstances, the ground begins to stabilize for teens who become involved parents despite significant challenges and hardships. Clinical Implications: Our results contribute to the visibility of teen fathers and the social disparities that imperil fathering. We provide clinical guidance for strengthening the ground for teen fathers and their families, recognizing that clinicians often encounter challenges such as interpersonal factors and sociocultural conditions that systematically erode fathers’ ties to their children, partners, professional caregivers, and institutions.
American Indian Women Cancer Survivor’s Needs and Preferences: Community Support for Cancer Experiences
Cancer (the focus of this inquiry) is the leading cause of death among American Indian and Alaska Native women. The purpose of this study was to identify American Indian women cancer survivors’ needs and preferences related to community supports for their cancer experience. This qualitative study examined female American Indian cancer survivors’ needs and preferences about community support. The sample included 43 American Indian women cancer survivors (the types of cancer survivors included cervical cancer: n = 14; breast cancer: n = 14; and colon and other types: n = 15) residing in the Northern Plains region, in the state of South Dakota. Data were analyzed using qualitative content analysis and were collected between June of 2014 and February of 2015. When asked about their needs and preferences, 82% of participants (n = 35) of female American Indian cancer survivors reported at least one of the following most commonly reported themes: cancer support groups (n = 31, 72%), infrastructure for community support (n = 17, 40%), and cancer education (n = 11, 26%). In addition to the aforementioned themes, 33% of participants (n = 14) indicated the need for an improved healthcare system, with 11% (n = 5) of participants expressly desiring the integration of spirituality and holistic healing options. The majority of American Indian women cancer survivor participants of this study identified a need for more community-based support systems and infrastructures to aid with the cancer survivor experience. Results warrant a community approach to raise awareness, education, and support for American Indian cancer survivors.
The impact of racism on the mental health of people of color
Twenty years later, racism remains an ever-relevant and ubiquitous force—whether named or unnamed—that impacts everyday life for many people of color. Racism, in all its forms, constitutes a significant risk to the mental health of people of color in the United States. This chapter names multiple forms of racism and briefly considers evidence suggesting their impact on the mental health of people of color. It reviews several theoretical frameworks that support conceptualization of racism as a stressor that operates on multiple levels (i.e., individual institutional, cultural) to influence mental health. Next, it provides a brief review of literature highlighting the impact of individual racism as well as institutional and cultural racism on mental health. The goal of this chapter is to summarize and provide perspective on the conceptual and empirical literature addressing the impact of racism on the mental health of people of color. It begins by providing an overview of the various forms of racism and presenting several models that can explain the racism-mental health link. Finally, the chapter provides a summary statement highlighting the significance of this important topic, as well as implications for improving the mental health suffering of people of color who experience racism.
The little kids down the hall: Associations between school climate, pre-K classroom quality, and pre-K children’s gains in receptive vocabulary and executive function
In recent years, policymakers’ and practitioners’ interest in school climate as a contributor to K-12 student learning and classroom processes has increased, both in the US and internationally. However, researchers have not yet examined the influence of school climate on the youngest learners in these contexts—prekindergartners. Using data from the Boston Public Schools, where the public prekindergarten program is housed in elementary schools, we explored associations among dimensions of school climate as reported by teachers and older peers, observed measures of prekindergarten classroom quality, and gains in children’s receptive vocabulary and executive function across the prekindergarten year. Student participants included 299 children attending full-day prekindergarten programs across 35 elementary schools in 61 classrooms. Findings indicated that school emotional climate had small positive association with prekindergarten classroom emotional support. School-level measures of teacher effectiveness also had positive associations with prekindergarten classroom levels of emotional support and classroom organization. School climate dimensions were not associated with children’s receptive vocabulary and executive function gains across the prekindergarten year. Results are discussed in the context of current school climate research and state-wide accountability efforts to assess school quality.
Relationship quality and comfort talking about sex as predictors of sexual health among young women
Dating relationships of young adults have gained increased attention in recent years. However, the relationship characteristics and interpersonal factors that are associated with positive sexual health outcomes among young women in monogamous, sexual relationships are not well understood. Using a sample of 339 young adult women, this study examined how relationship quality was associated with sexual health outcomes and whether these associations varied by comfort communicating about sex. Relationship quality and comfort communicating about sex was associated with pregnancy prevention and substance use during sexual activity. Comfort communicating about sex also moderated the link between relationship quality and taking more precautions to prevent pregnancy. Additionally, results indicated that young women who were more comfortable communicating about sex had higher odds of substance use during sexual activity. Findings suggest that research should not underestimate the potential sexual risk of monogamous relationships and that relationship characteristics should be discussed when practitioners are encouraging healthy sexual decision-making.
A mixed-methods investigation into the perspectives on mental health and professional treatment among former system youth with mood disorders
Research has shown that how people think about their health (or illnesses) shapes their help-seeking behavior. In this mixed-methods study, we employed a simultaneous concurrent design to explore the perceptions of mental illness among an understudied population: marginalized young adults. Participants were 60 young adults (ages 18-25) who had experienced mood disorders and used multiple public systems of care during their childhoods. Semistructured interviews were conducted to understand participants’ illness and treatment experiences during the transition to adulthood. A team of analysts used constant comparison to develop a codebook of the qualitative themes, and quantitative data were examined using SAS 9.3. Findings suggest that some theoretical categories identified in past illness-perceptions frameworks are salient to marginalized young adults (e.g., identity, management – or control – of symptoms), but both the developmental transition to adulthood and experiences with public systems of care add nuanced variations to illness and treatment perceptions. Our study demonstrates that young adults possess a set of beliefs and emotions about their mental health and help-seeking options that need to be better understood to improve engagement and quality of mental health care for this population. Implications for practice, research, and policy are discussed.
Empowerment among formal caregivers working with persons with dementia in home care
There is significant literature on workplace empowerment that focuses on individuals in positions of power rather than those who lack it. However, there is limited research on empowerment of home care workers, such as personal support workers (PSW) who work in dementia care. Empowerment is an active process based on a multifaceted model consisting of four components: meaning, self-determination, impact and competence. This study explored the roles of education and employer support in empowering PSWs to care for persons with dementia who live at home. Empowerment was investigated using semi-structured interviews with PSWs (N=15). A phenomenological approach was to understand the lived experiences of home-care based PSWs who work with persons with dementia. Components of empowerment were reflected through five emerging themes: “providing best care”, “autonomy”, “employer support”, “career long learning”, and “experiential learning”. The theme “providing best care possible” support the component of meaning, which included the motivation for training among PSWs and their value of aging in place. The theme “autonomy” supported the component of self-determination, which focused on PSW workload and feelings regarding their control working in home care versus long term care. The theme “employer support” supported the component impact, which included both PSW compensation and their perceived lack of emotional support. Finally, the themes “career-long learning” and “experiential learning”, were linked with impact and competence components, respectively. Overall, these findings support relationships between education and employer support in empowering PSWs who care for persons with dementia who live at home.
Health Policy and Social Work
This chapter provides an overall framework for understanding health policy that is essential to successful direct practice, advocacy, and policy making. The framework includes exposure to the key overall concerns of health policy—access, costs, quality, and accountability—as well as an introduction to the key organizational, finance, and payment structures in health care. The chapter then provides an introduction to the structure and key issues in Medicare, Medicaid, and the Children’s Health Insurance Program, the three main public insurance programs. It highlights the implications of repealing and replacing the Affordable Care Act for future policy and practice. Due to space considerations, the chapter focuses on federal health policy actions. For readers who are interested in state health policy issues, it suggests some additional resources. Finally, the chapter raises a set of policy issues and provides a number of key resources for ongoing involvement for social workers interested in understanding and influencing health policy.
Sociodemographic and substance use characteristics associated with typologies and composition of social support networks among youth experiencing homelessness in Los Angeles, USA
Youth experiencing homelessness are a vulnerable population with increased behavioural health risks. Social networks are a consistent correlate of youths’ substance use behaviours. However, less is known about the reciprocal relationships among these constructs. This study classified youth experiencing homelessness according to their social support network type (e.g. instrumental, emotional, service) and composition (e.g. family, peers, service staff) and linked their membership in these social network classes to sociodemographic and substance use characteristics. Four waves of cross‐sectional data were collected between October 2011 and June 2013 from youth experiencing homelessness, ages 14–29, at three drop‐in centres in Los Angeles, CA (N = 1,046). This study employed latent class analysis to identify subgroups of youth experiencing homelessness according to the type and composition of their social support networks. Multinomial logistic regression analyses were then conducted to identify the sociodemographic and substance use characteristics associated with social support network class membership. Five latent classes of youths’ social support networks were identified: (a) high staff emotional and service support; (b) high home‐based peer and family emotional, service and instrumental support; (c) moderate street‐ and home‐based peer emotional support; (d) low or no support and (e) high home‐based peer and family emotional and instrumental support. Multinomial logistic regression models indicated that race/ethnicity, gender, sexual orientation, literal homelessness, former foster care experience, depression, heroin and marijuana use were significant correlates of social support network class membership. Results indicate distinct classes of social support networks among youth experiencing homelessness, with certain sociodemographic and substance use characteristics implicated in youths’ social networks.
Characteristics and Factors Associated With Intimate Partner Violence–Related Homicide Post-Release From Jail or Prison
Intimate partner violence (IPV) victimization and perpetration are common experiences among incarcerated people. Despite knowledge regarding the challenges of re-integrating post-release from jail or prison, including an increased risk of homicide victimization, there is a dearth of research focused on IPV-related homicides post-release from a correctional facility. To address this gap, the current study used 2003-2015 data from the National Violent Death Reporting System from 27 states to examine the characteristics and circumstances surrounding IPV-related homicides soon after the homicide victim was released from jail or prison. Of the 126 post-release homicides, 13.5% were related to IPV. Post-release homicides involving either a female victim or perpetrator were more likely to be IPV-related. In the case of many of the IPV-related homicides, there was evidence of prior IPV as well as potential bystanders (including formal and informal supports) who were aware of the risk for IPV escalation and possible lethality. Compared with non-IPV post-release homicides, those related to IPV were more likely to occur in the victim’s home, have been immediately preceded by a physical fight, and have occurred by means other than firearm. These findings highlight the importance of enhancing the capacity of correctional facilities and community-based services to assess for and respond to risk of IPV and IPV-related lethality for individuals leaving correctional institutions.
Promoting Self-Awareness: An Undergraduate In-Class Activity and Its Value
Self-awareness is important in social work education because it promotes knowledge, skill, and value development. However, little is written about the ways in which educators facilitate this process. A project was undertaken to design a new self-awareness assignment (SAA) and examine its value. The SAA’s development, which relies on role-plays, is described. Results from an exploratory qualitative study that examined the value of the SAA on 80 undergraduate social work students’ knowledge and skills is presented. The results suggest the SAA is a positive teaching strategy for promoting students’ knowledge and skills development. Implications for social work education are discussed.
Cultivating Research Skills During Clinical Training to Promote Pediatric-Scientist Development
Physician-scientists represent a critical component of the biomedical and health research workforce. However, the proportion of physicians who spend a significant amount of effort on scientific research has declined over the past 40 years. This trend has been particularly noticeable in pediatrics despite recent scientific work revealing that early life influences, exposures, and health status play a significant role in lifelong health and disease. To address this problem, the Duke University Department of Pediatrics developed the Duke Pediatric Research Scholars Program for Physician-Scientist Development (DPRS). The DPRS is focused on research training during pediatric residency and fellowship. We aim to provide sufficient research exposure and support to help scholars develop a research niche and scholarly products as well as identify the career pathways that will enable them to achieve their research goals. Herein, we describe the DPRS’s organizational structure, core components, recruitment strategies, and initial results, and we discuss implementation challenges and solutions. Additionally, we detail the program’s integration with the department’s residency and fellowship training programs (with particular reference to the challenges of integrating research into small- to medium-sized residency programs) and describe the development and integration of related initiatives across Duke University School of Medicine. The program served as the basis for 2 successful National Institutes of Health Stimulating Access to Research in Residency (R38) applications, and we hope it will serve as a model to integrate formalized research training for residents and fellows who wish to pursue research careers in academic medicine.
Gender identity and sexual orientation development among young adult transgender men sexually active with cisgender men: ‘I had completely ignored my sexuality … that’s for a different time to figure out’
As awareness of issues faced by transgender individuals increases, many young people have been exposed to a dominant narrative about gender identity. Often these narratives are based on binary constructions about both sexual orientation and gender identity. The lack of diverse, representative cultural narratives has implications for identity development and sexual health. Transgender men who have sex with cisgender men in particular represent an understudied and overlooked population who likely experience unique developmental tasks related to the intersection of socially stigmatised sexual orientation and gender identities. This study explores sexual orientation and gender identity development among a sample of young adult transgender men who have sex with men. In-depth interviews using a modified life history method were conducted with 18 young men. Interview transcripts were coded using open, narrative and focused coding methods. Participants discussed milestones in the development of their sexuality and gender identity that map onto existing models, but also described ways in which these processes overlap and intersect in distinct ways. Findings highlight the need for human development models of sexual orientation and gender identity that integrate multiple identity processes. Implications for future research and practice to increase support for young adult transgender men are discussed.
Autonomic and affective mediators of the relationship between mindfulness and opioid craving among chronic pain patients
Prescription opioid misuse among chronic pain patients is undergirded by self-regulatory deficits, affective distress, and opioid-cue reactivity. Dispositional mindfulness has been associated with enhanced self-regulation, lower distress, and adaptive autonomic responses following drug-cue exposure. We hypothesized that dispositional mindfulness might serve as a protective factor among opioid-treated chronic pain patients. We examined heart-rate variability (HRV) during exposure to opioid cues and depressed mood as mediators of the association between dispositional mindfulness and opioid craving. Data were obtained from a sample of chronic pain patients (N = 115) receiving long-term opioid pharmacotherapy. Participants self-reported opioid craving and depression, and HRV was measured during an opioid-cue dot-probe task. Dispositional mindfulness was significantly positively correlated with HRV, and HRV was significantly inversely associated with opioid craving. Dispositional mindfulness was significantly negatively correlated with depression, and depression was significantly positively correlated with opioid craving. Path analysis revealed significant indirect effects of dispositional mindfulness on craving through both HRV and depression. Dispositional mindfulness may buffer against opioid craving among chronic pain patients prescribed opioids; this buffering effect may be a function of improved autonomic and affective responses.
Papilledema Treated by Cranial Expansion in a 5-Year-Old Boy with Camurati-Engelmann Syndrome
“That’s My Number One Fear in Life. It’s the Police”: Examining Young Black Men’s Exposures to Trauma and Loss Resulting From Police Violence and Police Killings
Black males are disproportionately the victims of police killings in the United States, yet few studies have examined their personal narratives of trauma and bereavement resulting from police violence. Informed by critical race theory and stress and coping theory, we used a modified grounded theory approach to conduct and analyze in-depth, semistructured life history interviews with 40 young Black men (aged 18-24 years) in Baltimore, Maryland. Study participants were recruited from a GED and job readiness center serving Baltimore youth. Study results offer a nuanced understanding of the patterning and mental health consequences of police violence for young Black men. Participant disclosures of witnessing and experiencing police violence began in childhood and spanned through emerging adulthood, met Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition criteria for trauma exposure, and embodied theoretical conceptualizations of racial trauma. Exposures to police violence fostered distrust of police and informed participants’ appraisals of their vulnerability to police violence across the life course. Six study participants disclosed losing loved ones to police killings. Injustice and hypervigilance accompanied grief. Implications for research, policy, and practice are discussed.
Asset-building and social inclusion: A qualitative analysis of families’ perspectives
Social inclusion has historically been one of the key goals of the welfare state. Over the past two decades, an increasing number of policies have aimed to promote inclusion by connecting low-income families to mainstream financial services and enabling them to save and acquire assets. Building on the concept of the “paradox of inclusion,” this article examines whether and how policies that aim to include low-income families in asset accumulation do so in ways that risk reinforcing their exclusion. The article focuses on a case study of a matched savings program in the heart of a major American city, gathering evidence through in-depth interviews with 24 clients in the program and ethnographic observations at the agency implementing the program.
The co-occurrence of adverse childhood experiences among children investigated for child maltreatment: A latent class analysis
Children investigated for maltreatment are particularly vulnerable to experiencing multiple adversities. Few studies have examined the extent to which experiences of adversity and different types of maltreatment co-occur in this most vulnerable population of children. Understanding the complex nature of childhood adversity may inform the enhanced tailoring of practices to better meet the needs of maltreated children. Using cross-sectional data from the National Survey of Child and Adolescent Well-Being II (N =5870), this study employed latent class analysis to identify subgroups of children who had experienced multiple forms of maltreatment and associated adversities among four developmental stages: birth to 23 months (infants), 2–5 (preschool age), 6–10 (school age), and 11–18 years-old (adolescents). Three latent classes were identified for infants, preschool-aged children, and adolescents, and four latent classes were identified for school-aged children. Among infants, the groups were characterized by experiences of (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) caregiver divorce. For preschool-aged children, the groups included (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) emotional abuse. Children in the school-age group clustered based on experiencing (1) physical neglect/emotional neglect and abuse/caregiver treated violently, (2) physical neglect/household dysfunction, (3) emotional abuse, and (4) emotional abuse/caregiver divorce. Finally, adolescents were grouped based on (1) physical neglect/emotional abuse/household dysfunction, (2) physical abuse/emotional abuse/household dysfunction, and (3) emotional abuse/caregiver divorce. The results indicate distinct classes of adversity experienced among children investigated for child maltreatment, with both stability across developmental periods and unique age-related vulnerabilities. Implications for practice and future research are discussed.
“And Slowly, the Integration and the Growing and the Learning”: Nuanced Notions of Integration of Bhutanese Refugees in US Cities
Policy related to refugee integration focuses on economic factors, while integration is not clearly operationalized nor is it being systematically measured and tracked in policy implementation. This study poses the question, how can local-level integration be conceptualized based on the perspectives of resettled refugees, to add nuance to policy. Using a case study approach with a nation-wide scale, data include 40 interviews and five focus groups with leaders of Bhutanese refugee-run organizations in 35 cities across the United States. Findings illustrate the importance of bonds, bridges and links in non-linear, relational integration. Findings also suggest that better access to services and resources is the responsibility of policy-makers and would lead to stronger bridges over time. This complicates existing policy and implies that resettlement programming should remain individualized and contextual from the ground level to the national level.
The Family Resilience Inventory: A Culturally Grounded Measure of Current and Family‐of‐Origin Protective Processes in Native American Families
The purpose of this article is to introduce the Family Resilience Inventory (FRI) and present findings on initial efforts to validate this measure. The FRI is designed to assess family resilience in one’s current family and in one’s family of origin, enabling the assessment of family protective factors across these generations. The development of the FRI was the result of many years of ethnographic research with Southeastern Native American tribes; yet, we believe that this scale is applicable to families of various backgrounds. Items for the FRI were derived directly from thematic analysis of qualitative data with 436 participants, resulting in two 20‐item scales. Due to missing data, eight cases were removed from the 127 participants across two tribes, resulting in an analytic sample size of 119. Conceptually, the FRI is comprised of two factors or scales measuring distinct dimensions of family resilience (i.e., resilience in one’s current family and resilience in one’s family of origin). The results of the confirmatory factor analysis supported the hypothesized two‐factor structure (X2(644) = 814.14, p = .03, X2/df = 1.10, RMSEA = .03, CFI = .97, TLI = .96). Both the subscales and the total FRI scale (α = .92) demonstrated excellent reliability. The results also provided preliminary evidence of convergent and discriminant validity. This measure fills a gap in the absence of community‐based, culturally grounded, and empirical measures of family resilience. The examination of family resilience, which may occur across generations, is an exciting new contribution of the FRI.