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.
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.
The role of maternal psychosocial perceptions in parent-training programs: a preliminary randomized controlled trial
Parent-child interaction is critical for early language and literacy development. Parent training programs have proliferated to support early interactions. However, many environmental and psychosocial factors can impact the quality of parent-child language and literacy interactions as well as training program outcomes. This preliminary randomized controlled trial examined maternal perceived self-efficacy and locus of control during a language and literacy parent training program. Thirty mother-child dyads (mother age 21-40; children 2;6-4;0) were assigned in parallel to the training or control group. The training was efficacious for mothers and children – training-group dyads made significantly greater gains in maternal strategy use, responsivity, and child print awareness than the control group. Gains were maintained one month post-training. Children whose mothers had more external baseline control perceptions identified significantly fewer print targets at baseline and made greater gains than those with more internal control perceptions. Future directions and implications are discussed.
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.
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.
Literacy of Breast Cancer and Screening Guideline in an Immigrant Group: Importance of Health Accessibility
Little is known about predictors of breast cancer literacy among immigrant women. A cross-sectional survey investigated predisposing, enabling, and need factors of breast cancer literacy among 233 Korean American women living in a southeastern U.S. city. Breast cancer literacy was measured by questions that asked awareness of cancer screening methods and a 5-item questionnaire derived from the American Cancer Society’s breast cancer screening guidelines and risk factors. Annual checkup was an enabling factor of awareness of Clinical Breast Exam (CBE) and mammogram, and also for breast cancer literacy covering the knowledge of breast cancer screening guidelines and risk factors. Health status was a need factor of CBE awareness. Marital status was a predisposing factor of mammogram awareness, and age and years of residence in the US were predisposing factors of breast cancer literacy. The findings of the study illuminate probable avenues of intervention to promote breast health knowledge for Korean American women.
Intimate partner violence victimization among college students with disabilities: Prevalence, help-seeking, and the relationship between adverse childhood experiences and intimate partner violence victimization
Intimate partner violence (IPV) is a major public health issue. Almost one third of college students in the U.S. experience IPV victimization. However, existing studies have focused primarily on college students without disabilities with little to no attention to college students with disabilities. In addition, few studies have explored the patterns of help-seeking and the relationship between adverse childhood experiences (ACEs) and IPV victimization among college students with disabilities. This study aimed to explore the prevalence of IPV victimization, ACEs, and help-seeking, the patterns of survivors’ help-seeking behaviors, and the relationship between ACEs and IPV victimization. Data from a cross-sectional online survey, which was conducted with samples from six universities in the U.S. and Canada (N = 3,308) between March 2016 and June 2017, were used. Descriptive bivariate and multivariate regression analyses were performed. The results show clear evidence that compared to college students without disabilities, college students with disabilities experienced higher rates of IPV victimization and ACEs. In addition, 42% of the survivors with disabilities sought some sort of support and they sought more formal support than their counterparts without disabilities. Furthermore, the associations between ACEs and IPV victimization among college students with disabilities were substantial after controlling for other risk factors. Specific, targeted university policies and programs as well as increased investment in programs that prevent ACEs are urgently needed to reduce violence against college students with disabilities.
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.
Can Precision Medicine Actually Help People Like Me? African American and Hispanic Perspectives on the Benefits and Barriers of Precision Medicine
To better understand African American and Hispanic perspectives on the potential benefits of precision medicine, along with the potential barriers that may prevent precision medicine from being equally beneficial to all. We also sought to identify if there were differences between African American and Hispanic perspectives. Six semi-structured focus groups were conducted between May 2017 and February 2018 to identify benefits and barriers to precision medicine. Three groups occurred in Nashville, TN with African American participants and three groups occurred in Miami, FL with Hispanic participants. At community-based and university sites convenient to community partners and participants. A total of 55 individuals participated (27 in Nashville, 28 in Miami). The majority of participants were women (76.5%) and the mean age of participants was 56.2 years old. Both African Americans and Hispanics believed precision medicine has the potential to improve medicine and health outcomes by individualizing care and decreasing medical uncertainty. However, both groups were concerned that inadequacies in health care institutions and socioeconomic barriers would prevent their communities from receiving the full benefits of precision medicine. African Americans were also concerned that the genetic and non-genetic personal information revealed through precision medicine would make African Americans further vulnerable to provider racism and discrimination in and outside of health care. While these groups believed precision medicine might yield benefits for health outcomes, they are also skeptical about whether African Americans and Hispanics would actually benefit from precision medicine given current structural limitations and disparities in health care access and quality.
Sleep coach intervention for teens with type 1 diabetes: Randomized pilot study
Teens with type 1 diabetes (T1D) experience increased sleep disturbances, which have been linked to problems with adherence and glycemic control. As such, sleep represents a novel target to improve outcomes in teens. To evaluate the feasibility, acceptability, and preliminary efficacy of a sleep-promoting intervention in teens with T1D. Teens aged 13 to 17 with T1D (n = 39) completed measures of sleep quality and diabetes management and wore actigraphs to obtain an objective measure of sleep. Hemoglobin A1C (HbA1c) was collected from medical records. Teens were randomized to Usual Care (n = 19) or the Sleep Coach intervention (n = 20). Teens in the Sleep Coach group received educational materials on healthy sleep habits and completed three individual telephone sessions. Follow-up data were collected at 3 months, including exit interviews with teens and parents. Feasibility of the study was excellent; 80% of teens in the Sleep Coach group completed all three sessions, and retention was high (90%). Based on actigraphy data, a significant improvement in sleep efficiency and sleep duration was observed (48-minute increase) among teens randomized to the Sleep Coach intervention, and teens in the control group were 7.5 times more likely to report poor sleep quality after 3 months than intervention participants. No change in HbA1c was observed. The Sleep Coach intervention for teens with T1D is a feasible and acceptable program that increased sleep duration and improved sleep quality for this high-risk population.
Beautiful stranger: Voices from the front lines of community practice in Israel
Over the past few decades, economic, political and cultural forces have altered the development of social policies and affected the life circumstances of oppressed communities in many countries. In response, calls for greater understanding and awareness of macro practice skills and interventions have been increasing within many of the social care professions. These calls have been particularly strong within the social work profession. A major field in macro social work is community practice, which aims to help people organise, plan and act for change. To date, there has been a dearth of studies examining social workers’ involvement in community practice at the ground level. Drawing on in‐depth interviews with 26 community social workers in public social services in Israel, this qualitative study examines community social workers’ everyday experiences of community practice and the meanings they attribute to it. Findings highlight three main themes: (a) the elusive and unbounded nature of community practice; (b) the tense relations that community social workers maintain with various actors within the profession; and (c) the complex relations they maintain with the communities in which they work. We discuss these findings in light of Georg Simmel’s concept of ‘the stranger’. Implications to community practice are outlined.
Making the Connection Between Theories of Policy Change and Policy Practice: A New Conceptualization
Over the past few decades, powerful economic, political and cultural forces have restructured the welfare state and social work practice. In response, there have been calls in recent years for the re-politicisation of the social work profession. One of the main ways in which social work has been re-politicised is through the emphasis on social workers’ involvement in the policy arena, commonly referred to as ‘policy prac-tice’ in the literature. Although policy practice has recently received close attention in social work debates, it has remained relatively under-theorised. This article introduces social work scholars and practitioners to the theoretical work on policy change and elaborates its implications for how social workers can influence policy. Drawing on diverse literatures from the fields of political science and sociology, the article circum-scribes to four influential theories of policy change that provide support for informed action in the policy arena: neo-institutional theory, elite theory, resource mobilisation theory and interdependent power theory. Drawing on these theories, the article develops a conceptualisation of four different types of policy practice: institutional policy practice, elite policy practice, resource-based policy practice and radical policy practice.
Social work and the state: Perspectives and practice
The state has been central to social work throughout the profession’s history. Despite its theoretical and political significance, the mainstream of the social work field has long disregarded the state as an object of inquiry. The scant attention given to the state within social work is especially puzzling given a resurgence of interest in the state within the social sciences over the past few decades. To redress this imbalance, this article explores six influential theories of the state and discusses their implications for social work practice and policy. These theories suggest we conceive of the state as: a liberal and caring guardian; a tool for class dominance; a means of social control; a political practice; an institutional structure; and a cultural construct. Drawing on diverse literatures, the article advances the understanding of social work that takes seriously the problem of the state.
The initial development and validation of the Racial Socialization Competency Scale: Quality and quantity
The present study investigated the reliability and validity of the Racial Socialization Competency Scale (RaSCS). As posited by the Racial Encounter Coping Appraisal and Socialization Theory (RECAST), the RaSCS consists of 3 factors representing 3 novel dimensions of racial socialization competency present in families (e.g., stress, skills, and confidence). Responses to the RaSCS were collected from 361 self-identified Black and African American parents and primary caretakers across the United States. After factor analysis, three scales and 27 items were maintained. Evidence was consistently found for 2 subscales within the stress dimension, namely “Call to Action” and “General” racial socialization stressors. Dimensions were also related to their respectively hypothesized constructs, including overall stress, racial socialization frequency, and self-efficacy. Future directions and recommendations on the measure’s use, particularly in the context of interventions, are also discussed.
Test-Taking for Gifted and Talented Kindergarten: Underscoring the Importance of Outreach
Using proprietary data collected prior to the establishment of the public Universal Prekindergarten program in New York City, this study finds statistically significant differences in test-taking rates for the city’s Gifted & Talented (G & T) program between two matched samples of students—those who attended a public prekindergarten (pre-K) program and those who did not—for each of four cohorts from 2008 to 2011, favoring the public pre-K group. Results also demonstrate that access to information about the G & T program is a plausible mechanism underlying the higher test-taking rates among the public pre-K group, especially for underrepresented groups. With the establishment of the Universal Prekindergarten in New York City in 2015, our results highlight the importance of instituting new policies for promoting the dissemination of information regarding the G & T admissions process within the public school sector. If targeted to address diversity in G & T, such policies could help reduce inequality in gifted education.
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.
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.
The role of elementary school and home quality in supporting sustained effects of pre-K
Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (NICHD SECCYD), we used 2-level random effects models to examine whether the quality of school and home environments during elementary school moderated associations between pre-K quality and math, reading, and vocabulary achievement from first through fifth grade. Results showed that the quality of the home environment moderated the association between pre-K quality and children’s vocabulary achievement. Supportive home environments during elementary school had an additive effect over and above the positive effects of pre-K quality in predicting children’s vocabulary achievement. In contrast, when children experienced high levels of pre-K quality and lower quality home learning environments, the positive effects of pre-K were less likely to be sustained. Findings suggest the importance of considering programs and policies to support home-based learning as one potential mechanism to sustain early effects of pre-K.
The mediating role of child-teacher dependency in the association between early mother-child attachment and behavior problems in middle childhood
This study examines child-teacher dependency in preschool as a pathway through which mother-child attachment is associated with children’s behavior problems across middle childhood. Data include direct assessments of attachment security and styles, teacher reports of child-teacher dependency, and maternal reports of behavior problems from the NICHD SECCYD (N = 769 children). Children with more secure attachments at 24 months were less likely to exhibit child-teacher dependency at 54 months. Children with ambivalent, controlling, or insecure/other attachments at 36 months had higher levels of child-teacher dependency at 54 months. Results from multi-level models showed that child-teacher dependency at 54 months was associated with higher levels of internalizing, but not externalizing, behavior problems across middle childhood. Child-teacher dependency partially mediated the association between insecure/other mother-child attachment and internalizing behaviors in middle childhood. Supporting preschool teachers to reduce child-teacher dependency may help ameliorate risk for internalizing behaviors posed by insecure/other attachment.
Time well spent: Home learning activities and gains in children’s academic skills in the prekindergarten year
Parental engagement in home-based learning activities is linked to children’s academic skills. Yet, interventions that try to enhance parental engagement—sometimes targeted to families with low levels of education—have small effects. This study aimed to inform supports for families by examining how different types of home-based learning activities influence academic skills during prekindergarten. We created four measures that assessed the frequency with which parents (N = 307) engaged in unconstrained and constrained language/literacy and math activities at home. Unconstrained language activities predicted gains in children’s language skills, and unconstrained math activities were associated with gains in math skills. Both associations were larger for families with lower versus higher levels of parental education. Engagement in constrained activities did not predict gains in skills. Implications for practice and research are discussed.