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.
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.
“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.
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.
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.
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.
Can Center-Based Care Reduce Summer Slowdown Prior to Kindergarten? Exploring Variation by Family Income, Race/Ethnicity, and Dual Language Learner Status
This study examines growth in language and math skills during the summer before kindergarten; considers variation by family income, race/ethnicity, and dual language learner status; and tests whether summer center-based care sustains preschool gains. Growth in skills slowed during summer for all children, but the patterns varied by domain and group. Non-White and dual language learner students showed the largest drop-off in language skills during summer. Lower-income students demonstrated slower summer growth in math skills than their higher-income peers. Students enrolled in summer center-based care had faster growth in math skills than those who did not attend care. Yet lower-income students who attended center-based care showed slower growth in language skills during summer than similar nonattenders. Implications are discussed.
On the Front Lines of the COVID-19 Pandemic: Occupational Experiences of the Intimate Partner Violence and Sexual Assault Workforce
In the face of increasing risk for intimate partner violence (IPV) and sexual assault during the COVID-19 pandemic, there is an urgent need to understand the experiences of the workforce providing support to survivors, as well as the evolving service delivery methods, shifting safety planning approaches, and occupational stress of frontline workers. We addressed this gap by conducting an online survey of members of IPV and sexual assault workforce using a broad, web-based recruitment strategy. In total, 352 staff from 24 states participated. We collaborated with practitioner networks and anti-violence coalitions to develop the brief survey, which included questions about work and health, safety planning, and stress. We used chi-square, t-test, and ANOVA analysis techniques to analyze differences within position and demographic variables. For qualitative data, we used thematic analysis to analyze responses from four open-ended questions. The sample was majority female-identified (93.7%) and essential workers in dual IPV and sexual assault programs (80.7%). Findings demonstrated that since the pandemic began, IPV and sexual assault staff are experiencing more personal and professional stressors, perceive a decrease in client safety, and lack resources needed to help survivors and themselves. Common problems included a lack of food or supplies at home and work and housing and financial support for survivors. There was a 51% increase in the use of video conference for work, which contributed to workforce strain. Reductions in overall service capacity and a shift to remote service provision have implications for both survivors and staff. These findings suggest a critical need for additional training, infrastructure, and support for the IPV and sexual assault workforce. There is an urgent need to classify IPV and sexual assault staff as first responders and address the occupational stress associated with the COVID-19 pandemic.
“Problem Children” and “Children with Problems”: Discipline and Innocence in a Gentrifying Elementary School
This article examines the ways Hazel, a white girl entering kindergarten, became known as a child with a problem rather than a problem child in her gentrifying school. Building on a year of classroom observations and interviews with students, school staff, and parents, author Alexandra Freidus identifies the role of racialized discourses related to disposition, medicalization, family, and community in shaping Hazel’s reputation and contrasts Hazel’s reputation with that of Marquise, a Black boy in her class. Hazel’s and Marquise’s storylines teach us that to fully understand and address the differences in how Black and white children are disciplined, we need to look closely at the allowances and affordances we make for some students, as well as how we disproportionately punish others. By examining the ways educators in a gentrifying school construct white innocence and Black culpability, this study illustrates the relational nature of the “school discipline gap” and helps us understand how and why some children are disproportionately subject to surveillance and exclusion and others are not.
A Meta-Analysis of Acculturation and Enculturation: Bilinear, Multidimensional, and Context-Dependent Processes
Acculturation and enculturation are currently conceptualized as bilinear, multidimensional, and context-dependent cultural socialization processes (Yoon et al., 2013). Yet, this conceptualization requires further specification and empirical evidence. Our work is timely given the downward shift in productivity of traditional acculturation research and the need for a new direction. We examined the constructs and processes of acculturation and enculturation by meta-analytically synthesizing the findings of 255 publications (343 independent samples). In support of a bilinear (vs. unilinear) conceptualization, we found that acculturation and enculturation were only slightly associated with each other, r = −.18. In support of multidimensionality and context-dependency, their relationship varied by dimension (e.g., nonsignificant association of mainstream and ethnic identities vs. significant associations in other dimensions), geographic region, and race. Additionally, acculturation and enculturation rates/patterns varied by dimension; extrinsic changes (e.g., behavior) proceeded faster than intrinsic changes (e.g., values, identity). We discuss a direction for future research and implications for practice, advocacy, and education/training.
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.
Inequality in Isolation:: Educating Students with Disabilities during COVID-19