Intimate Partner Violence Survivors’ Unmet Social Service Needs

ABSTRACT

Women who have experienced intimate partner violence (IPV) victimization are at risk for physical and mental health problems, as well as social and economic challenges. In this cross-sectional study, 173 adult, English-speaking women who had experienced police response to IPV completed a self-report questionnaire about their use of, interest in, and need for various social services and whether or not each type of service helped (or would help) them to feel safer. More than three quarters of the participants reported a current need for health and economic support services. There was less interest in traditional IPV resources: law enforcement and domestic violence counseling or shelter. Expanding services to meet survivors’ needs for health care and economic independence may facilitate long-term safety. Recommendations for further research in this area are provided.     

Multiple assessors of child welfare youths' mental‐health functioning: comparing perceptions of adolescents,caregivers and teachers

For youth involved with the child welfare system, accurate assessment of mental‐health functioning is a critical factor in case planning. To assess correspondence among multiple reporters of child welfare youths' mental‐health difficulties, this study, using data drawn from the National Survey of Child and Adolescent Well‐being dataset, examined the caregiver, teacher and youth (aged 11–16 years) reports on the Child Behavior Checklist (n = 464). Perceptions about symptomatology on a variety of externalizing and internalizing behaviour problem scales were measured with a correlation analysis. Subsequently, logistic regression models were created, which explored how each reporter category matched a fourth reporter category: the child welfare investigation caseworkers' identification of youths' mental‐health needs. Results show that in several models, the odds of matching caseworkers' determination of youths' mental‐health needs significantly increased as youths' perceptions of psychopathology increased. A similar pattern was found for caregivers' perceptions in some of the models, across both internalizing and externalizing domains. Implications for child welfare practice and research with child welfare youth are discussed.     

Assessing Health Care Needs Among Street Homeless and Transitionally Housed Adults

ABSTRACT

This study examined the health services received and needed among homeless persons in Hillsborough County, FL (N = 823). Lifetime and current need and receipt of health services were assessed with a cross-sectional survey. Participants reported extensive lifetime and current needs for physical and behavioral health care services. Nearly a third of participants reported current unaddressed health problem(s); an inability to obtain needed health care; and feelings of unaddressed mental health issue(s) as well as substance abuse problem(s) in the past year. Future research on homelessness and health should focus on identifying different pathways to health and mental health services for this vulnerable population and the outcomes of these interventions.     

Reducing Alcohol Abuse in Gay Men: Clinical Recommendations From Conflicting Research

ABSTRACT

Gay men entering the health care system present with unique needs essential for health care providers to comprehend and address. While data indicate mental health and substance abuse disorders are more prevalent among gay men compared with their heterosexual counterparts, the literature assessing abuse of alcohol by gay men is conflicting. This article explores the conflicting research examining the use and abuse of alcohol by gay men, common findings and themes among studies addressing the issue, the theoretical concepts of internalized homophobia and heterosexism as they relate to alcohol abuse, and clinical strategies providers can implement when encountering this issue among their gay male patients. This comprehensive assessment of the literature will also provide direction for future critical inquiries and outline ways to improve the current methods of inquiry.     

A 12-Month Follow-Up Evaluation of Integrated Treatment for Homeless Individuals With Co-Occurring Disorders

ABSTRACT

This study examined the effectiveness of the Comprehensive, Continuous, Integrated System of Care (CCISC) model in addressing co-occurring mental health and substance use disorders. Clients were eligible for participation if they had co-occurring disorders and were homeless or at risk of homelessness. Forty-eight clients received a comprehensive array of services consistent with the CCISC model. Measures assessing housing, employment, mental health, and substance use were completed at baseline, 6-month, and 12-month follow-up. Results demonstrated significant improvements in housing, employment, mental health, and substance use at 12-month follow-up. These results underscore the effectiveness of implementing evidence-based care.     

Incremental Validity of Stressful Life Experiences in Predicting Psychiatric Comorbidity Among Women in Substance Abuse Treatment

ABSTRACT

The dynamic contribution of stressful life experiences in predicting psychiatric comorbidity continues to challenge clinical practice and research. This study tested incremental validity of stressful life experiences related to psychiatric comorbidity among 128 young women in a Midwestern substance abuse treatment facility. Respondents reported low income, homelessness, and health and mental health issues. Using the Addiction Severity Index (ASI), Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Text Revision, and Stressful Life Experience (SLE) Screen as correlates, hierarchical linear regression demonstrated support for incremental validity of SLE uniquely accounting for 6.5% of variance in ASI psychiatric scores. Findings support future use of SLE in clinical settings for assessment and intervention purposes.     

Economic Status,Family Dependence,and Health Outcomes of Older People in Western Rural China

There is a deficiency in empirical knowledge on the physical and mental health of lower-income older people with weak family support in western rural China. To address this research gap, this article uses the data from the 2014 China Longitudinal Aging Social Survey to analyze the disadvantaged situation of older people in western rural China through a regional comparative analysis. Our sample consisted of 7,138 older adults aged 60 or older in eastern and western, rural and urban China. We find that lower personal income is significantly associated with poor physical and mental health. Economic support from families means more for older people when they have a disability related to activities of daily living in western rural China. Fostering stronger family support networks might improve the mental health status of older people in western rural China. Our study suggests a broader scope for the state to play a greater role in economic empowerment and in the development of policies to effectively meet the present and future needs of older people in western rural China or other countries with an imbalance in the distribution of the aging population and welfare resources.     

‘I am the face of success’: peer mentors in child welfare

Child welfare systems have struggled to create innovative, culturally sensitive programmes to address the multiple and pervasive barriers that exist in engaging child welfare parent clients in their service plans. Peer mentor programmes—those in which parents who have successfully navigated the child welfare system and reunified with their children, mentor parents newly entering the system—are designed to address some of these barriers, to improve reunification outcomes. Focus groups with parent clients (n = 25) and interviews with peer mentors (n = 6) were conducted to identify the characteristics of peer mentoring programmes that are critically helpful to parent clients, as well as the mechanisms that allow peer mentors to be effective in their work. The qualitative analysis uncovered three general themes to which both parents and peer mentors frequently referred in interviews—the value of shared experiences, communication and support. Additionally, the study found that peer mentorship has positive effects not only on parent clients but also on the mentors themselves. The inclusion of peer mentors in child welfare practice suggests an important paradigm shift within child welfare that could lead to culture change for the field.     

On the Value and Meaning of Trauma-Informed Practice: Honoring Safety,Complexity, and Relationship

ABSTRACT

In social work, as in other mental health fields, there has been a surge of literature regarding trauma-informed practice. Even so, the value and meaning of being a trauma-informed practitioner still call for further explication and analysis, especially in the realm of clinical social work practice. Approaching and engaging traumatized clients with a trauma-informed lens carry profound implications in the assessment, diagnostic, and intervention stages of treatment, and these implications warrant further unpacking. Additionally, it is critical to explore, through real-world case examples, the significance of working with a trauma-informed lens. This article develops a stage-based, relational definition of trauma-informed practice and argues that trauma-informed practice prioritizes client complexity, social context, and the therapeutic relationship throughout the assessment, diagnostic, and treatment process. In addition, it prioritizes the nuanced experiences and needs of the client, in particular the need for safety, above specific treatment modalities. In this way, it has vital importance to the field of social work. The significance of being trauma informed is considered at all stages of treatment and will be illuminated through practice examples and a longer clinical vignette.     

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.     

Effects of Placement Changes on Health Insurance Stability Among a National Sample of Children in the Child Welfare System

ABSTRACT

Children in the child welfare system have entitlements to health insurance coverage—critical because of their considerable physical and mental health needs—based largely on their placement status. This study conducted path and transitions analyses on data from the National Survey of Child and Adolescent Well-Being (3,801 children followed-up for 3 years) to examine the interplay between placement changes and insurance stability. Children maintained in-home at Wave 1 had significantly lower odds of being insured (OR = 0.7); children transitioning from out-of-home placement to in-home care had significantly lower odds of maintaining insurance coverage (OR = 0.6). Child welfare workers working with children maintained in-home and those being reunified should safeguard the children's insurance status. Policy makers should consider extension of categorical eligibility to all children presenting to child welfare agencies in order to assure access to needed services for these vulnerable children.     

Methodology for Discovering and Teaching Countertransference Toward Elderly Clients

Abstract

This article will describe a method that has been effective in helping students, paraprofessional counselors as well as mental health professionals identify countertransference reactions in themselves. It offers instructors and clinical supervisors a way to teach about countertransference toward elderly clients. This technique can be utilized in a variety of work settings such as classrooms, mental health clinics, multi-purpose centers for older adults and private practice.     

Supportive Housing for Addicted,Incarcerated Homeless Adults

ABSTRACT

Homeless populations often suffer from mental illness, substance abuse, and criminality. Interventions, such as supportive housing, can have positive impacts, although benefits can be limited. This study examined outcomes for clients (N = 102) of a new supportive housing intervention. Use of formal treatment, jail contact, and community stability were compared pre- and post-housing. Jail bookings and residential substance abuse treatment significantly declined post-housing, while clients improved in income level, access to food, and housing stability. Results from official justice and treatment system data suggest that supportive housing can lead to significant changes. Future research is necessary to understand the relationship between client characteristics and outcomes.     

Advance Care Planning in the Delivery of Adult Protective Services

ABSTRACT

In ensuring the safety and protection of older adults from abuse and exploitation, adult protective services (APS) workers face a variety of situations involving serious illness and end-of-life conditions. Many older adults encountered in APS will present with one or more chronic conditions that may warrant discussion of advance care planning with clients and their families. This study surveyed APS workers (n = 508) in 21 states regarding encounters with end-of-life situations and the practice of future care planning. Results revealed that three-fourths of APS workers encounter clients with serious illnesses and about two-thirds do discuss planning in advance for care. More than one-half of the respondents indicated client incapacity and refusal to address future care needs as barriers to discussing planning in advance for care. Recommendations to enhance advance care planning among APS workers are discussed.     

Incorporating self‐determination into substance abuse prevention programming for youth transitioning from foster care to adulthood

Youth transitioning from foster care to adulthood are at higher risk for alcohol and substance abuse disorders than general population youth. At the same time, these youths are often recipients of strong clinical intervention, often at levels considered unnecessary, for other mental health or behavioural challenges. Because of this, there is sometimes resistance from providers to offer services such as substance abuse prevention programming as it may be seen as contributing to youths' overclinicalization, stigmatization, or retraumatization. Using thematic content analysis, this qualitative study analysed focus groups with community stakeholders providing recommendations on support services for youth transitioning from foster care to adulthood to derive strategies for delivering substance abuse prevention programming in a way that enhances youth self‐determination. Findings were organized by self‐determination theory's 3 key psychological needs: autonomy, competence, and relatedness. All three needs were represented in stakeholder recommendations, which were translated into strategies for bolstering youths' achievement of each need. Strategies include a mix of those already present in motivational interviewing‐based brief substance abuse prevention interventions as well as more unique strategies that are much less frequently employed but that may better meet the needs of youth with foster care experience.     

Economic distress and health: A fixed effects analysis of low‐income persons in Singapore

Using fixed effects regressions, this study examined the transactional effects of different types of economic status on the physical and mental health of low‐income persons in Singapore. Among the economic variables considered, unemployment and arrears had the most significant effects. This signals the physical and psychological distress of being out of work and possessing arrears while income is low. The insignificant effects of poor health on household earnings suggest possible earnings supplementation by other household members. The findings imply the fruitfulness of dually improving employment prospects and health, work activation that takes into consideration mental health effects, increasing affordability of health services in liberal welfare systems, improving mental bandwidth through reducing arrears accounts, and short lag time from application to receipt of assistance. These implications point to a larger question on health and welfare systems in an increasingly uncertain economic environment for households in poverty. Key Practitioner Message: ? Employment and health are inter‐related: employment assistance incorporating physical and mental health interventions and vice versa can be more effective than either alone; ? Compared with decreasing arrears amounts, reducing the number of arrears can more effectively relieve mental distress; ? Effects between economic distress and health materialise quickly; minimising the lag time between application and receipt of assistance will provide great relief.     

Substance Use Decision-Making – Are Clinicians Using the Evidence?

Clinical assessment and treatment decision-making is a complex, everyday task for the substance use workforce. This Canadian study conducted with community substance use providers in the Interior region of British Columbia examines the factors clinicians pay attention to in their decision-making. A randomized factorial survey approach, using three unique vignettes embedded with factors of interest, was used to test the effect of case and respondent factors on assessment and treatment decisions. Responses were received from 106 participants, representing approximately a 35% response rate, yielding a sample size (n) of 308 vignettes. Multiple regression tested the independent effects of the vignette and clinician factors on assessment and treatment decisions. Factors within the vignette associated with withdrawal, physical illness and mental health issues emerged as the most predictive elements. The social complexity of people’s lives, client’s stated treatment preferences and readiness for change, and respondent characteristics were obscured in decision-making. This study indicates a lack of fidelity in the use of core assessment and treatment-matching tools, suggesting that clinician decision-making may, in everyday practice, be more heuristic and evidence-informed than evidence-based. Further research on normative decision-making practices in the substance-field is warranted.     

Commitment of Private and Public Agency Workers to Child Welfare: How Long Do They Plan to Stay?

ABSTRACT

Method: Child welfare professionals completing training to work in foster care were asked about reasons for taking their child welfare position, commitment to their agencies, and commitment to child welfare. Analyses compared responses from new public agency foster care workers (N = 100), public agency workers making lateral transfers to foster care (N = 64), and new private foster care workers (N = 105).

Results: Private agency foster care workers were less committed to their agencies and to child welfare and more likely to have taken the position because it was the only one available.

Conclusions: The practice by public child welfare of outsourcing foster care services to private agencies needs to be evaluated. This practice may not benefit children in care and may create organizational problems for agencies.     

Human Capital, Physical Health, and Mental Health of Welfare Recipients: Co-occurrence and Correlates

Drawing on a large random sample of welfare recipients in the post–welfare reform era, this article examines the prevalence of mental health disorders, substance dependence, and physical health or disability, their co-occurrence with human capital problems, and their relation to employment. Half of the participants have none of these potential barriers to employment. Mental health and human capital problems, when present, tend to occur in isolation about half the time. Women with co-occurring human-capital, mental-health, and physical-health problems have the poorest work outcomes. The findings suggest the need to design and implement more assessment, referrals, and service provision to support women in meeting the challenges in the transition from welfare to work.