Organizing as “Collective-Self” Care Among African American Youth in Precarious Times
African American youth have responded with hope and action to protect their well-being in violent political, economic, and social conditions, through organizing. While contemporary organizing frameworks prioritize self-care to promote sustainability, there is little research on the meaning and definition of self-care for African American youth organizers, in their own words. In this paper, findings from interviews with 20 Black youths in navigating organizing spaces in New York City will be presented, highlighting how they destabilize the narrowness of commonly defined self-care to embody “collective-self” care strategies. Implications for community practice, recovery from systemic violence, and historical trauma among African Americans will be explored.
#PrEP4Love: success and stigma following release of the first sex-positive PrEP public health campaign
Pre-exposure prophylaxis (PrEP) is an effective yet under-utilised method for preventing HIV transmission in high-risk groups. Despite ongoing social marketing to increase PrEP awareness, few studies have evaluated public responses. This paper contextualises negative responses to Chicago’s PrEP4Love campaign. In February 2016, a sex-positive ad campaign called PrEP4Love was launched online and throughout public spaces in Chicago. A gender and sexuality inclusive campaign, PrEP4Love is intended to be culturally responsive and sex positive, while retaining a focus on risk reduction. Advertisements prominently feature Black sexual minority men, and Black transgender women, and were strategically placed in diverse Chicago neighbourhoods. In response, there were 212 new callers to the PrEPLine during the two-month study period. Negative responses were concerned with: negatively depicting Black homosexuality (4), general anti-LGBTQ comments (7), adverse effects on children (6), sexually explicit nature (5), and general stigmatisation of racial minorities (4). Discussion focuses on sex-positive frameworks, normalising intimacy, stigma and historical mistrust of medical and pharmaceutical institutions, and the social meanings of biomedical prevention technologies (e.g. PrEP) in relation to dominant norms of sexuality and gender. This study is the first to investigate public responses to a sex-positive PrEP campaign. More studies of PrEP social marketing are needed to evaluate targeted public health campaigns to guide future PrEP promotion strategies.
Examining Caretaker Attitudes Towards Primary Prevention of Pediatric Behavioral Health Problems in Integrated Care
Understanding caretaker attitudes towards the prevention of pediatric behavioral disorders is important for the effective delivery of prevention services. Caretakers of children ages 0–18 (N = 385) read a description of pediatric prevention services in an integrated primary care setting. Attitudes towards these services were assessed. The majority of participants (80%) agreed that prevention is important, 87% reported interest in learning their child’s risk for a behavioral disorder, 84% were interested in learning the results of a screen for behavioral disorders, and 88% were interested in learning parenting strategies. Participants endorsed similarly positive attitudes towards prevention in integrated care. Perceived risks outweighing perceived benefits, younger caregiver age, and identifying as non-Hispanic White predicted less favorable attitudes towards prevention. Other socio-demographic characteristics (e.g., caretaker education) were associated with disorder-specific beliefs about the importance of prevention, but not general attitudes. Findings suggest generally positive attitudes towards preventing behavioral disorders in an integrated care setting.
The Process of Change in Systemic Family Therapy
This chapter provides a comprehensive review of the research on the processes of change in systemic family therapy (SFT). We begin by clearly defining SFT process research including what it fully entails: systemically oriented mechanisms and contexts of change. Our review of the research is uniquely organized according to our view of the evolution of SFT practice (a) beginning with an overview of process findings from the traditional schools of SFT, (b) followed by findings from empirically supported treatments in SFT, and then (c) finalized by an assessment of the research from an integrative perspective of SFT including common and unique change processes (systemic alliances, systemic engagement and retention, systemic reframing, and systemic enactments). Following this overview, we provide directions for future areas of research that will need to be explored in order to more fully articulate the pathways of change in SFT including the need to better clarify the contexts in which certain process are most important. Finally, several implications for SFT training and practice are articulated including how this review points to the need for a potential paradigm shift that squarely places systemically oriented principles of change and client system‐centered integration and at the heart of our work.
The effect of Medicaid expansion on use of opioid agonist treatment and the role of provider capacity constraints
To determine the effect of Medicaid expansion on the use of opioid agonist treatment for opioid use disorder (OUD) and to examine heterogeneous effects by provider supply and Medicaid acceptance rates. Yearly state-level data on methadone dispensed from opioid treatment programs (OTPs), buprenorphine dispensed from OTPs and pharmacies, number of OTPs and buprenorphine-waivered providers, and percent of OTPs and physicians accepting Medicaid. This study used difference-in-differences models to examine the effect of Medicaid expansion on the amount of methadone and buprenorphine dispensed in states between 2006 and 2017. Interaction terms were used to estimate heterogeneous effects. Sensitivity analyses included testing the association of outcomes with Medicaid enrollment and state insurance rates. The estimated effects of Medicaid expansion on buprenorphine and methadone dispensed were positive but imprecise, meaning we could not rule out negative or null effects of expansion. The estimated associations between state insurance rates and dispensed methadone and buprenorphine were centered near zero, suggesting that improvements in health coverage may not have increased OUD treatment use. The effect of Medicaid expansion was larger in the states with the most waivered providers compared to states with the fewest waivered providers. In the states with the most waivered providers, the average estimated effect of expansion on buprenorphine dispensed was 12 kg/y, enough to treat about 7500 individuals. We did not find evidence that the effect of expansion was consistently modified by OTP concentration, OTP Medicaid acceptance, or physician Medicaid acceptance. Gains in health coverage may not be sufficient to increase OUD treatment, even in the context of high treatment need. Provider capacity likely limited Medicaid expansion’s effect on buprenorphine dispensed. Policies to increase buprenorphine providers, such as ending the waiver requirement, may be needed to ensure coverage gains translate to treatment access.
Gender Differences in Intimate Partner Violence Victimization, Help-Seeking, And Outcomes Among College Students
Many college students experience intimate partner violence (IPV). Although receiving help from formal and informal sources may ameliorate possible negative impacts of IPV victimization, the outcomes of help-seeking are not always positive. This study used survey data collected at six universities across the United States (U.S.) to examine gender differences in IPV, help-seeking, and its outcomes (n=3,070). Major variables included IPV victimization, IPV consequences, help-seeking, and outcomes. Descriptive and bivariate analyses revealed higher rates of victimization among females as well as poorer health status, higher levels of depression, and more daily routine problems. Females also used more formal help, and reported it as being useful more often than males. Inversely, more males than females reported that informal supports were helpful. Recommendations include social workers providing tailored services both for male and female survivors, service providers developing educational programs that target informal help sources, and social work education providing relevant trainings.
Marginalized Youth, Mental Health, and Connection with Others: A Review of the Literature
For marginalized youth, the transition to adulthood is a stage of life in which inequalities can be either magnified or reduced. While most descriptions of these young people highlight their difficulties achieving self-sufficiency, the ability to form connections with others is an equally significant marker of adult maturity. Given that social isolation poses serious risks to health and well-being, the relational experiences of marginalized youth are a critical component of the transition to adulthood. Experiences of trauma, marginalization, and involvement in public systems of care can place these youth at heightened risk for mental health difficulties, all of which can pose particular challenges for interpersonal relationships. This critical review of the literature explores the research on the relational experiences of marginalized young people living with emotional and behavioral challenges. It discusses the unique developmental context of marginalized youth, including experiences with trauma, mental illness, marginalization, and involvement in public systems of care. It then reviews the benefits young people derive from mutually empathic connections with others. The review explores facilitators of connection for marginalized youth, as well as barriers to connection for these young people. Following this review, the article identifies several gaps in the literature, and ends with a call for both practitioners and researchers to focus on the importance of connection as an underappreciated and crucial resource for marginalized youth.
Rethinking classroom quality: What we know and what we are learning
As the federal and state governments increasingly invest in ECE programs to improve their quality, MDRC is leading several studies that conceive and measure the quality of ECE classrooms in new and innovative ways. In particular, MDRC is focusing on instructional quality by examining promising instructional practices, such as the use of rich content and individualized activity settings and the promotion of higher-order skills within a broad range of learning domains. In doing so, MDRC aims to improve the understanding of the critical aspects of instructional quality that promote school readiness among low-income children and their sustained academic success as they move through elementary school and beyond.
Intimate Partner Violence in India: Abuse in India’s Empowered Action Group States
Married women in India experience intimate partner violence (IPV) at alarming rates. This study explores regional differences in Indian women’s physical IPV experiences by looking at the effect of living in eight Empowered Action Group (EAG) states. It is hypothesized that women in EAG states will be more likely to have experienced physical IPV than women living outside EAG states. A sample of 65,587 women was selected from the 2005-2006 India National Family Health Survey (NFHS-3). Counter to our hypothesis, logistic regression results show that living in an EAG state decreases likelihood of physical IPV in the past 12 months.
MRI Insights Into Adolescent Neurocircuitry—A Vision for the Future
Adolescence is the time of onset of many psychiatric disorders. Half of pediatric patients present with comorbid psychiatric disorders that complicate both their medical and psychiatric care. Currently, diagnosis and treatment decisions are based on symptoms. The field urgently needs brain-based diagnosis and personalized care. Neuroimaging can shed light on how aberrations in brain circuits might underlie psychiatric disorders and their development in adolescents. In this perspective article, we summarize recent MRI literature that provides insights into development of psychiatric disorders in adolescents. We specifically focus on studies of brain structural and functional connectivity. Ninety-six included studies demonstrate the potential of MRI to assess psychiatrically relevant constructs, diagnose psychiatric disorders, predict their development or predict response to treatment. Limitations of the included studies are discussed, and recommendations for future research are offered. We also present a vision for the role that neuroimaging may play in pediatrics and primary care in the future: a routine neuropsychological and neuropsychiatric imaging (NPPI) protocol for adolescent patients, which would include a 30-min brain scan, a quality control and safety read of the scan, followed by computer-based calculation of the structural and functional brain network metrics that can be compared to the normative data by the pediatrician. We also perform a cost-benefit analysis to support this vision and provide a roadmap of the steps required for this vision to be implemented.
Associations Between Service Members’ Posttraumatic Stress Disorder Symptoms and Partner Accommodation Over Time
When service members manifest symptoms of posttraumatic stress disorder (PTSD), intimate partners may engage in behaviors to accommodate their partners’ experiences (e.g., helping service members avoid situations that could make them uncomfortable, not expressing own thoughts and feelings to minimize PTSD‐related conflict), which may inadvertently serve to maintain or increase PTSD symptoms over time. In a sample of 274 male service member/female civilian couples, we evaluated hypothesized bidirectional pathways between self‐reported service member PTSD symptoms and partner accommodation, assessed four times over an approximately 18‐month period. A random‐intercept cross‐lagged panel model disaggregating between and within effects revealed that, on average, couples in which the service member had higher levels of total PTSD symptoms also scored higher in partner accommodation, between‐couple correlation, r = .40. In addition, at time points when service members’ PTSD symptoms were higher relative to their own average symptom level, their partners’ level of accommodation was also higher than their personal average, within‐couple correlation r = .22. Longitudinally, service member PTSD symptom scores higher than their personal average predicted subsequent increases in partner accommodation, β = .19, but not vice versa, β = .03. Overall, the findings indicate both stable and time‐specific significant associations between service member PTSD symptoms and partner accommodation and suggest that higher levels of PTSD symptoms are a significant driver of later increases in partner accommodation. These findings add further support for treating PTSD in an interpersonal context to address the disorder and concomitant relational processes that can adversely impact individual and relational well‐being.
Children and the Welfare State: The Need for a Child-Centered Analysis
Variation in child well-being across rich Western nations suggests that the welfare state may play a role in shaping child well-being. However, welfare scholars have largely overlooked children in their analyses. This paper seeks to bring children to the center of welfare state analysis by examining how comparative welfare state theory can consider child well-being. The paper begins with an examination of Esping-Andersen’s seminal work, The Three Worlds of Welfare Capitalism, which has come to frame welfare state analysis for nearly three decades. Next, the paper explores the main critiques of Esping-Andersen’s work, with special attention paid to the feminist critique and the construction of alternative feminist and family policy regimes. Finally, this paper extends and reworks Esping-Andersen’s Three Worlds to offer a new framework for conducting child-centered welfare state analyses.
“Listen and Let It Flow”: A Researcher and Participant Reflect on the Qualitative Research Experience
Ethnographic research involves prolonged and often personal interaction between the researcher and research participants. This paper is a collaboration between a social work researcher and a research participant who became acquainted through the researcher’s ethnographic fieldwork for her dissertation. Despite differing in numerous and significant ways, not the least of which are age, class, education, and race, the two women developed a quasi-friendship after the researcher exited the field–a time when many researcher-participant relationships wane or terminate entirely. The two recorded and transcribed a series of informal conversations wherein they reflected on their experiences in the research process. Of particular salience is the research participant’s perspective of the immaterial benefits she experienced through her participation in the research and her perception of the qualities of a “good” qualitative researcher: one who approaches listening as a practice and cultivates relationships with participants slowly and naturally. The authors’ reflections indicate that participants may be able to offer valuable feedback on the research experience, and researchers might use participants’ unique perspectives to alter their research approach and/or techniques.
The Impact of the COVID-19 Pandemic on College Student Mental Health: A Longitudinal Examination of Risk and Protective Factors
The spread of the novel coronavirus has led to unprecedented changes in daily living. College students may face unique challenges associated with these changes. In the present study, college students (N = 205) completed a battery of questionnaires in April of 2020, after having completed similar measures 8, 5, and 2 months prior as part of a larger study. A repeated measures ANOVA suggested significantly greater depression and anxiety symptom severity during the pandemic than at any other time during the 2019-2020 academic year. Static and modifiable factors associated with psychological distress and controlling for pre-existing psychological distress were examined. Cognitive and behavioral avoidance was the most consistent predictor of psychological distress during the pandemic. Online social engagement and problematic Internet use also conferred greater risk. Women and Latinx participants were more likely to experience elevated distress during the pandemic, even when controlling for distress prior to the pandemic.
“Mental Health Is for Crazy People”: Perceptions and Barriers to Mental Health Service Use among Refugees from Burma
Good mental health is essential to successful integration for refugee populations that resettle in the U.S. We explored perceptions of mental illnesses and barriers to mental health service use as well as solutions to current mental health problems from the perspective of refugees. The interviews with a convenience sampling of 11 community leaders (6 men and 5 women) from various Burmese ethnic communities revealed three major categories, including sources of mental illnesses (e.g. traumatic experiences and post-resettlement challenges), barriers to service use (e.g. lack of understanding about mental health, linguistic challenges, cultural stigma, alternative treatments, and unresponsive system), and proposed community solutions (e.g. community education, culturally-competent providers, and beyond mental health treatment). The findings suggest that the ethnic community can be a source of potential solutions to mitigate barriers to mental health service use.
Getting a Clinical Innovation into Practice: An Introduction to Implementation Strategies
Just as there is a robust science that supports development and rigorous testing of clinical innovations, the emerging field of implementation science is developing new theory-based knowledge regarding a growing portfolio of meticulously tested implementation strategies that seek to improve uptake of evidence-based practices by targeting barriers at multiple levels within health care settings. Studying and documenting implementation strategies associated with uptake during the development and trial of a clinical innovation could subsequently position the researcher for a more seamless transition and handoff of the innovation to clinical and operational leaders.The objective of this manuscript is to introduce the concept of implementation strategies: what they are; the rigor with which they are defined and applied to address barriers to clinical innovation adoption; how strategy selection may vary based on contextual, innovation, and recipient factors; how to document the application of strategies over the course of an implementation study; and how testing their effectiveness is the focus of implementation research trials.
Adherence to Cervical Cancer Screening in Korean American Immigrant Women: Identifying Malleable Variables for Intervention Development
Despite Korean American women having a high incidence rate of cervical cancer, many are unaware of the significance of Pap test. The purpose of this research was to examine the rates of Pap test receipt and factors associated with the uptake. The study was guided by Andersen’s Model of Health Service Use and used a cross-sectional research design. A sample of 230 women residing in metro-Atlanta, Georgia, participated in this study. Results. Slightly more than half (55.7%) had lifetime Pap tests while less than half (45.7%) had it within the last 3 years. Binary logistic regression indicated that marital status, monthly income, and annual checkups were significantly correlated with receiving Pap tests. Special attention is needed for women who are unmarried and have low income to increase Pap test receipt. Suggested intervention programs include better communication strategies, extended Medicare coverage, and outreach programs within Korean American community.
Assessing trustworthiness: Marginalized youth and the central relational paradox in treatment
Marginalized youth are at elevated risk for mental health difficulties, yet they encounter numerous barriers to engagement with mental health services. Past negative experiences with family, social workers, and systems of care contribute to distrust of service providers and ambivalence about engaging in trusting relationships with adults. This longitudinal qualitative study explored how marginalized youth living with mental health conditions make decisions about trust in their relationships with helping professionals. Semi-structured, open-ended in-depth interviews were conducted with 13 young women living with a mood or anxiety disorder, exploring trust, mutuality, and disconnection in relationships between marginalized youth and helping professionals. Eleven of the participants also participated in a second interview, 3 months later, that explored participants’ relationships with friends and family. Transcripts were analyzed using thematic analysis and interpreted through the lens of relational-cultural theory. Results indicated that the majority of interview participants described feeling unseen, judged, or invalidated in their relationships with family members. Four themes emerged as factors in the assessment of the trustworthiness of service providers: genuine caring; understanding; non-judgmental acceptance; and adult respect for youth agency. Concerns about confidentiality and mandated reporting informed participants’ decisions about disclosure in these relationships. Analysis of findings reveals evidence of the central relational paradox in these descriptions of helping relationships, reflecting the simultaneous appeal and peril of vulnerability in relationships, especially relationships characterized by power differentials. Findings suggest that practitioners working with marginalized youth can expect both openness and guardedness in the treatment relationship.
The Effect of Mentoring on School Attendance and Academic Outcomes: A Randomized Evaluation of the Check & Connect Program
Chronic absenteeism in early grades has been found to be predictive of high school dropout, but little is known about effective solutions to reduce absenteeism. Researchers conducted a randomized evaluation of Check & Connect (C&C), a school-based mentoring program, to evaluate its impact on school attendance and academic outcomes. The study was conducted in Chicago Public Schools (CPS) from 2011-2015. For students who began the program in grades 5-7, the program decreased student absences and caused participating students to fail fewer courses. However, there were no measurable effects of participating in the program for students who began the program in grades 1-4.
Mixed-Methods Randomized Evaluation of FAMS: A Mobile Phone-Delivered Intervention to Improve Family/Friend Involvement in Adults’ Type 2 Diabetes Self-Care
Family and friends have both helpful and harmful effects on adults’ diabetes self-management. Family-focused Add-on to Motivate Self-care (FAMS) is a mobile phone-delivered intervention designed to improve family/friend involvement, self-efficacy, and self-care via monthly phone coaching, texts tailored to goals, and the option to invite a support person to receive texts. We sought to evaluate how FAMS was received by a diverse group of adults with Type 2 diabetes and if FAMS improved diabetes-specific family/friend involvement (increased helpful and reduced harmful), diabetes self-efficacy, and self-care (diet and physical activity). We also assessed if improvements in family/friend involvement mediated improvements in self-efficacy and self-care. Methods Participants were prospectively assigned to enhanced treatment as usual (control), an individualized text messaging intervention alone, or the individualized text messaging intervention plus FAMS for 6 months. Participants completed surveys at baseline, 3 and 6 months, and postintervention interviews. Between-group and multiple mediator analyses followed intention-to-treat principles. Retention, engagement, and fidelity were high. FAMS was well received and helped participants realize the value of involving family/friends in their care. Relative to control, FAMS participants had improved family/friend involvement, self-efficacy, and diet (but not physical activity) at 3 and 6 months (all ps < .05). Improvements in family/friend involvement mediated effects on self-efficacy and diet for FAMS participants but not for the individualized intervention group. The promise of effectively engaging patients’ family and friends lies in sustained long-term behavior change. This work represents a first step toward this goal by demonstrating how content targeting helpful and harmful family/friend involvement can drive short-term effects.