Responding to Crisis of Aging People in Prison: Global Promising Practices and Initiatives
The “aging prisoner” crisis continues to gain international attention. The high human, social, and economic costs of warehousing older adults with complex physical, mental health, social, and spiritual care needs in prison continue to rapidly increase at a disproportionate rate compared to the general prison population. Over the past two decades, there has been some national and international movement in corrections and the community for programs, initiatives, and policies that foster the physical, mental, social, spiritual, and economic well-being of older adults. These promising practices often included comprehensive case management services for medical, mental health, substance abuse, family, social services, housing, education, or vocational programs. Program-specific aspects include one or more of the following: “age” and “cognitive capacity” sensitive environmental modifications, interdisciplinary staff and volunteers trained in geriatric-specific correctional care, complimentary medicine, specialized case coordination, the use of family and inmate peer supports and volunteers, mentoring, and self-help advocacy group efforts.
Toward an Experimental Therapeutics Approach in Human Services Research
Over the past decade, the experimental therapeutics approach has gained currency as an organizing framework for research in mental health. However, examples of this approach outside of person-directed therapeutic and preventive interventions have been relatively uncommon. This article describes an experimental therapeutics approach to mental health and human services research that considers the role of social and ecological determinants in a person’s recovery from mental disorder. To illustrate this approach, this article decomposes an employment intervention to show three of its components and identifies the targets for two components: social relationships and health insurance. These targets can be engaged by provider-, community-, or policy-level interventions. Such applications of an experimental therapeutics approach to research on mental health services can enhance the rigor of studies and thereby contribute to the well-being of persons living with mental disorders in the United States.
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.
Development of a Dementia-Focused End-of-Life Planning Tool: The LEAD Guide (Life-Planning in Early Alzheimer’s and Dementia)
Background and Objectives: To address the unique characteristics of Alzheimer’s disease and related dementias (ADRD) that complicate end-of-life (EOL), we created, refined, and validated a dementia-focused EOL planning instrument for use by healthy adults, those with early-stage dementia, family caregivers, and clinicians to document EOL care preferences and values within the current or future context of cognitive impairment. Research Design and Methods: A mixed-method design with four phases guided the development and refinement of the instrument: (1) focus groups with early-stage ADRD and family caregivers developed and confirmed the tool content and comprehensiveness; (2) evaluation by content experts verified its utility in clinical practice; (3) a sample of healthy older adults (n = 153) and adults with early-stage ADRD (n = 38) completed the tool, whose quantitative data were used to describe the psychometrics of the instrument; and (4) focus groups with healthy older adults, family caregivers, and adults with early-stage ADRD informed how the guide should be used by families and in clinical practice. Results: Qualitative data supported the utility and feasibility of a dementia-focused EOL planning tool; the six scales have high internal consistency (α = 0.66–0.89) and high test–rest reliability (r = .60–.90). On average, both participant groups reported relatively high concern for being a burden to their families, a greater preference for quality over length of life, a desire for collaborative decision-making process, limited interest in pursuing life-prolonging measures, and were mixed in their preference to control the timing of their death. Across disease progression, preferences for location of care changed, whereas preferences for prolonging life remained stable. Discussion and Implications: The LEAD Guide (Life-Planning in Early Alzheimer’s and Dementia) has the potential to facilitate discussion and documentation of EOL values and care preferences prior to loss of decisional capacity, and has utility for healthy adults, patients, families, providers, and researchers.
Mindfulness-Based Stress Reduction Versus a Health Enhancement Program in the Treatment of Urge Urinary Incontinence in Older Adult Women: A Randomized Controlled Feasibility Study
Current treatment practices for older adult women with urge urinary incontinence (UUI) remain insufficient and ineffective. A randomized controlled feasibility trial was developed to evaluate three determinants of research feasibility and three determinants of intervention feasibility when comparing mindfulness-based stress reduction (MBSR) with a health enhancement program (HEP) in older adult women with UUI. Participants were recruited from the university health system, county senior centers, and community sites. Twenty-five postmenopausal women (mean age = 74 years) were randomized into MBSR treatment conditions or HEP comparison conditions for an 8-week intervention. Participants remained blinded to conditions. Research feasibility determinants were measured as recruitment, retention, and treatment delivery; intervention feasibility determinants were measured as acceptability, tolerability, and client receipt/enactment. Feasibility determinants established in the research literature as essential to intervention evaluation were recorded and evaluated throughout the current study. All six feasibility determinants confirmed positive results in the enrolled population. The use of MBSR and HEP as the active comparison to treat UUI in older adult women proved feasible in this trial. The results warrant the design of a larger-scale, multisite trial to study the efficacy of MBSR in treating UUI in older adult women.
Trauma-informed care with women diagnosed with postpartum depression: a conceptual framework
Postpartum depression (PPD) is a mental health disorder that affects approximately 20% of all new mothers. PPD frequently co-occurs with and is exacerbated by trauma, particularly for women from vulnerable populations. Trauma-informed care (TIC) is a best practice that recognizes the importance of, and takes steps to promote recovery from, trauma while preventing retraumatization. Despite its potential utility, there is limited research published on TIC, including how TIC is operationalized across practice settings. Further, despite the prevalence and negative effects of untreated PPD, to date there have been limited articles published on TIC and PPD. The purpose of this article is to provide a TIC framework for service delivery for women diagnosed with PPD including explicit strategies for how TIC should be structured across roles, settings, and systems. Implications for health practice, policy, and future research are provided.
Public Health Social Work as a Unifying Framework for Social Work’s Grand Challenges
Introduced in 2013 by the American Academy of Social Work and Social Welfare, the Grand Challenges for Social Work (GCSW) implicitly embrace a public health perspective. However, the lack of a specific overarching conceptual framework creates a challenge for moving the GCSW from concept to practice. In this article, authors propose that public health social work (PHSW) provides a unifying framework for moving the GCSW from concept to practice. Authors undertook a review of the literature, including a review of published literature and all Web sites and other Web materials focused on the GCSW. Three GCSW were selected to illustrate the utility of PHSW and the social work health impact model (SWHIM): (1) stopping family violence, (2) eradicating social isolation, and (3) achieving opportunity and justice. Using a wide-lens PHSW approach, the illustrations focus on actions that can influence populations through strengthened environments and multilevel interventions. The public health field reflects the rigorous science behind the theoretical models, community-based approaches, and attention to effects of social determinants of health at the population level. Because health and inequalities are the focus of many of the GCSW, incorporating both public and population health, together with the SWHIM, can help provide structure to achieve collective goals.
Preadolescents’ Daily Peer Victimization and Perceived Social Competence: Moderating Effects of Classroom Aggression
Few studies have assessed children’s daily peer experiences, and even fewer have considered their daily self-perceptions. This daily diary study examined relations between preadolescents’ daily reports of peer victimization and perceived social competence, along with moderating effects of classroom aggression. A racially diverse sample of 182 children in 5th grade (105 boys; M age = 10.64 years; 35% White, 31% Black, 17% Hispanic, 17% other or not reported) completed daily measures of peer victimization and perceived social competence, with most children completing measures on 8 school days. Teachers completed measures of aggression for each participating pupil. Four types of peer victimization (verbal victimization, social manipulation, social rebuff, and property attacks) predicted decreased daily perceived social competence. Daily social rebuff predicted decreased daily perceived social competence beyond the effects of the other types of victimization. Classroom aggression moderated the relation of verbal victimization with perceived social competence, such that this relation was significant in classrooms with lower aggression and nonsignificant in classrooms with higher aggression. Results indicate that preadolescents’ daily self-perceptions fluctuate with daily victimization by peers, particularly with social rebuff. Findings also suggest that the impact of verbal victimization on children’s self-views could be exacerbated in classrooms that better manage peer-to-peer aggression. Accordingly, targeted interventions appear critical for children who continue to experience peer victimization in schools with highly effective aggression prevention programs.
Relations between Reactive and Proactive Aggression and Daily Emotions in Adolescents
The current study examined whether individual differences in reactive and proactive aggression: 1) relate to level of daily emotion, including happiness, sadness, anger, and fear, 2) predict across-day variability in these emotions, and 3) moderate reactivity of these emotions to positive and negative events. Participants were a racially/ethnically diverse sample of 144 adolescents (80 girls, 64 boys; M age = 13.55 years; SD = 1.34). Adolescents self-reported on reactive and proactive aggression in a home visit prior to the collection of daily data. Using daily dairy procedures, adolescents then reported on their daily emotions and positive/negative events over 12 consecutive days. Higher reactive aggression was associated with greater levels of daily anger, more variability in anger across days, and heightened angry reactivity to negative events. Additionally, higher reactive aggression predicted lower levels of daily happiness but greater happy reactivity to positive events. Finally, higher reactive aggression was linked to increased variability in daily fear. In contrast, proactive aggression was largely unrelated to adolescents’ daily emotions, with the exception that higher proactive aggression predicted less variability in happiness across days. Results indicate that reactive aggression is characterized by significant emotionality at the daily level, and proactive aggression is characterized by lack of emotionality.
Mentoring Connections: Implementing a Student–Alumni Mentor Program in Social Work
A student-alumni mentor program that combines aspects of academic and workplace mentoring was developed and implemented in a school of social work. Foundation-year MSW students (mentees) were matched with school of social work alumni (mentors) in a formal mentoring program. This program was developed to address the needs of MSW students, alumni, and the school of social work by providing students with a professional mentor and fostering ongoing connections and opportunities for involvement for alumni. A model for designing, developing, and implementing this program is presented. Benefits of the program for students, mentors, and the school are discussed as well as lessons learned during implementation.
Challenges in health-care service use among Burmese refugees: A grounded theory approach
The timely use of health-care services is essential to achieve the best health outcomes. We explore barriers to health-care access among refugees from Burma through interviews with key community informants who serve their community as interpreters, health-care professionals, paraprofessionals, and/or representatives. The interviews with a convenience sampling of 11 leaders from Burmese and Karen ethnic communities revealed three stages of health-care use (i.e., before, during, and after doctor’s appointments), in which their community members encounter difficulties in accessing health-care services. Using grounded theory analysis approach, specific difficulties and cultural considerations for each stage were emerged. This study suggests that training programs for health-care providers on refugee populations’ needs, cultural expectations, attitudes, and health behaviors may ease the process for refugees during each of these three stages. Interpreters as cultural brokers have an important role in facilitating cross-cultural communications not only before and during the appointment but also after doctor’s visits, such as in the pharmacy and labs.
Understanding the Relationship Between Staff and Job Satisfaction, Stress, Turnover, and Staff Outcomes in the Person‐Centered Care Nursing Home Arena
Background: The provision of quality care in nursing home (NH) facilities is an ongoing challenge, and the literature indicates that the quality of care (QOC) is often suboptimal. While it is highly recommended that NH facilities adopt a culture of person‐centered care (PCC) to ensure quality care, the outcomes of this shift on staff working in NH settings has not been well studied. The purpose of this article was to understand the theoretical relationship between staff and job satisfaction, stress, turnover, and staff outcomes in PCC NH settings, by utilizing Cohen‐Mansfield’s (1995) comprehensive occupational stress model. Methods: An integrative review of the electronic databases of research published in English between 2000 and 2015 was conducted. Results: A review of 11 papers suggested that job satisfaction in the nursing workforce is positively related to consistency in QOC delivery and increased quality of life among residents in NHs. Management support and PCC practices positively correlate with improved QOC, staff satisfaction, and staff retention. Conclusions: This review showed that PCC intervention and training representing the key concept of workplace resources has a positive impact on NH staff job stress and satisfaction. Clinical Relevance: Supporting the NH workforce through PCC training is essential for promoting job satisfaction and reducing job‐related stress as well as turnover, which in turn will improve QOC delivered to the residents living in NHs.
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.
A Culturally Informed Systematic Review of Mental Health Disparities Among Adult Indigenous Men and Women of the USA: What is known?
Related to a broader context of historical oppression, Indigenous peoples of the USA are overburdened with the mental health challenges that social workers tend to treat, including post-traumatic stress disorder (PTSD), depression, suicide and substance use disorders (SUD). The purpose of this systematic review is to use the Framework of Historical Oppression, Resilience and Transcendence (FHORT) to identify empirical research on risk and protective factors related to mental health and SUD amongst these populations. This systematic review includes peer-reviewed quantitative and qualitative research articles from 1980 to 2017 focusing on the mental health of US Indigenous adults. A total of thirty-eight peer-reviewed empirical articles met inclusion criteria. Results reveal adults within Indigenous populations are at a high risk for mental health outcomes, including PTSD, depression, suicide, SUD and comorbidity across these outcomes. Underlying risk factors across outcomes included historical oppression and loss, family problems and SUD. Protective factors tended to include family and social support and engagement with tribal cultural activities. Significant variability was identified based on gender and geographic regions. Given that protective factors tended to include cultural, familial and community tenets, holistic approaches are the most promising programmes for social workers to work towards.
Effectiveness of the Adolescent Depression Awareness Program (ADAP) on Depression Literacy and Mental Health Treatment
BACKGROUND: Analysis of data from a NIMH‐supported study was conducted to evaluate the effectiveness of the Adolescent Depression Awareness Program (ADAP) in promoting depression literacy and help‐seeking behavior. METHODS: Eighteen Pennsylvania schools were matched on size, sex, race, test scores, median income, and free/reduced lunch status. Schools randomized to the intervention implemented ADAP as a compulsory part of the schools health curriculum, while control schools collected study measures. RESULTS: Post‐randomization analysis revealed no significant differences by sex on the pre‐assessments between intervention and control schools. In the intervention schools, a total of 1427 students received ADAP. Written parental consent and adolescent assent was obtained from 33.7% students. The online REDCap survey was completed by 41.78% of the consenting students. The Adolescent Depression Knowledge Questionnaire (ADKQ) findings suggest that ADAP significantly improved depression knowledge (Est. =1.07, SE =.25, p < .001), compared to those in the control group. ADAP was found to facilitate help‐seeking behavior by student report in those participating in the REDCap survey 4 months following the ADAP curriculum. CONCLUSIONS: Results of the survey suggests that ADAP facilitates help‐seeking behaviors in teens. This study supports the efficacy of a teacher delivered school‐based universal prevention program, ADAP, on depression literacy
Unwanted Sexual Experiences in University Settings: Survivors’ Perspectives on Effective Prevention and Intervention Strategies
Unwanted sexual incidents on university campuses pose significant public health and safety risks for students. This study explored survivors’ perspectives on secondary prevention of campus sexual assault and effective strategies for intervention programs for unwanted sexual incidents in university settings. Twenty-seven student survivors of unwanted sexual experiences participated in semi-structured in-depth interviews. Data were analyzed using thematic analysis and a constructionist perspective. The findings were contextualized using the ecological model. Barriers to reporting included concerns about one’s story not being believed, personal minimization of the incident, belief that no action will be taken after reporting, confidentiality concerns, and other perceived costs of reporting. Survivors provided valuable insight on potentially effective prevention and intervention strategies to address the problem of unwanted sexual incidents on university campuses. These findings may be useful for prevention and intervention policies and programs in university settings and for providers who assist survivors of unwanted sexual experiences.
Relationships of Reproductive Coercion and Intimate Partner Violence to Unintended Pregnancy
Setting: Six participating states contributed data from the Pregnancy Risk Assessment Monitoring System (PRAMS). Participants: Data were obtained for 20,252 women who gave birth between 2012 and 2015 and completed the PRAMS survey within 9 months of giving birth. Methods: Weighted descriptive statistics and multivariate logistic regression models were used to assess the influence of RC and IPV on odds of UIP. Results: Approximately 2.7% (n = 600) of participants reported physical IPV, and 1.1% (n = 285) reported RC. Participants less than 30 years of age, with low socioeconomic status, who were single and of Black or Hispanic race/ethnicity were at significantly increased risk of IPV. With the exception of Hispanic race/ethnicity, these sociodemographic characteristics were also associated with an increased risk for RC. Participants who experienced IPV had a nearly eightfold increased risk of RC (adjusted odds ratio = 7.98, 95% confidence interval [CI] [4.68, 13.59]) than their nonabused counterparts. In univariate models, RC, IPV, or RC with IPV were significantly associated with increased odds of UIP (odds ratio [OR] = 2.18, 95% CI [1.38, 3.44]; OR = 2.36, 95% CI [1.75, 3.19]; OR = 3.55, 95% CI [1.56, 8.06], respectively); however, results were nonsignificant after adjusting for sociodemographic factors. Conclusion: In this population-based sample, we confirmed that there were links among IPV, RC, and UIP, all factors associated with poor maternal and infant outcomes. Screening for IPV and RC is an important step toward reducing rates of UIP.
Standing on the Shoulders of Giants: Matthew O. Howard as a Mentor and His Influence on the Science of Mindfulness as a Treatment for Addiction
It is difficult to estimate the impact of a scholar. Conventional metrics such as citation counts, h-indexes, publications in top-tier journals, and federal grants all provide some objective indication of scholarly impact, but these indices fail to capture the holistic and historical context of a scholar’s influence on the development and emergence of entirefields of inquiry. To obtain a more comprehensive sense of scholarly impact, a reviewer with close knowledge of both the scholar and the field is required. As his student and colleague, I believe that Matthew Owen Howard, PhD, exerted a singular influence on social work research, and his scholarly efforts helped give rise to a new and critically important field of scientific investigation: the study of mindfulness as a treatment for addiction.
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.
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.